Provider Demographics
NPI:1871843037
Name:SESSA, MARYELLEN (RN)
Entity Type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:
Last Name:SESSA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 PERIMETER STREET
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3821
Mailing Address - Country:US
Mailing Address - Phone:631-872-6470
Mailing Address - Fax:
Practice Address - Street 1:271 PERIMETER STREET
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-3821
Practice Address - Country:US
Practice Address - Phone:631-872-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660919-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse