Provider Demographics
NPI:1356153449
Name:MUDARO, GIANNA (LPN)
Entity type:Individual
Prefix:
First Name:GIANNA
Middle Name:
Last Name:MUDARO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 COLLEGE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1448
Mailing Address - Country:US
Mailing Address - Phone:631-740-6050
Mailing Address - Fax:
Practice Address - Street 1:700 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2952
Practice Address - Country:US
Practice Address - Phone:631-863-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347393-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse