Provider Demographics
NPI:1336724731
Name:GUADAGNO, PAMELA ANN I
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:GUADAGNO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 BRENTWOOD RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5543
Mailing Address - Country:US
Mailing Address - Phone:631-299-3004
Mailing Address - Fax:
Practice Address - Street 1:1725 BRENTWOOD RD BLDG 1
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-5543
Practice Address - Country:US
Practice Address - Phone:631-299-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse