Provider Demographics
NPI:1134583107
Name:BIONDO, REGINA (RN)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:BIONDO
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 1:183 WILLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1263
Mailing Address - Country:US
Mailing Address - Phone:516-622-0064
Mailing Address - Fax:
Practice Address - Street 1:183 WILLOWOOD DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1263
Practice Address - Country:US
Practice Address - Phone:516-622-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495243-1163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care