Provider Demographics
NPI:1023459740
Name:MYERS, RENATA (NP)
Entity type:Individual
Prefix:MRS
First Name:RENATA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:RENATA
Other - Middle Name:
Other - Last Name:DANILEYKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-427-3700
Mailing Address - Fax:631-427-0347
Practice Address - Street 1:790 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-427-3700
Practice Address - Fax:631-427-9149
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 605560163W00000X
NY40 401623363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse