Provider Demographics
NPI:1891195350
Name:SCHIAVETTA, KIERA (PA-C)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:
Last Name:SCHIAVETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SCUDDER PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3025
Mailing Address - Country:US
Mailing Address - Phone:631-300-8715
Mailing Address - Fax:
Practice Address - Street 1:72 SCUDDER PL
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3025
Practice Address - Country:US
Practice Address - Phone:631-300-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant