Provider Demographics
NPI:1134855265
Name:VIRGILIO, MICAELA (NP)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:VIRGILIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SUNRISE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4921
Mailing Address - Country:US
Mailing Address - Phone:516-531-7836
Mailing Address - Fax:
Practice Address - Street 1:200 SUNRISE HWY FL 2
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4921
Practice Address - Country:US
Practice Address - Phone:516-531-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350116-01363LF0000X
NY736422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse