Provider Demographics
NPI:1922153618
Name:SWAYZE, ROGER DALE (RN)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:DALE
Last Name:SWAYZE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-6199
Mailing Address - Country:US
Mailing Address - Phone:718-920-2221
Mailing Address - Fax:718-653-2237
Practice Address - Street 1:3400 BAINBRIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2221
Practice Address - Fax:718-653-2237
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY535513-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator