Provider Demographics
NPI:1922337278
Name:SPERICO, PETER STEVEN (FNP)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:STEVEN
Last Name:SPERICO
Suffix:
Gender:M
Credentials:FNP
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Mailing Address - Street 1:1056 GARDINER DRIVE
Mailing Address - Street 2:PETER SPERICO NURSE PRACTITIONER IN FAMILY HEALTH PC
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6314
Mailing Address - Country:US
Mailing Address - Phone:516-455-3413
Mailing Address - Fax:631-969-0093
Practice Address - Street 1:1056 GARDINER DRIVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6314
Practice Address - Country:US
Practice Address - Phone:516-455-3413
Practice Address - Fax:631-969-0093
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2011-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY336101363LF0000X, 363L00000X
NY409409163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse