Provider Demographics
NPI:1831501923
Name:VARUGHESE, THRESIAMMA
Entity Type:Individual
Prefix:
First Name:THRESIAMMA
Middle Name:
Last Name:VARUGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONYBROOK UNIVERSITY HOSPITAL
Mailing Address - Street 2:HSCT16-080,NICHOLS ROAD
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-3821
Mailing Address - Fax:631-444-1056
Practice Address - Street 1:STONYBROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:HSCT16-080,NICHOLS ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-3821
Practice Address - Fax:631-444-1056
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306659-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health