Provider Demographics
NPI:1639903396
Name:PETROSINO, SIERRA DIOR (RN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:DIOR
Last Name:PETROSINO
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 1:1 BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6153
Mailing Address - Country:US
Mailing Address - Phone:518-491-8951
Mailing Address - Fax:
Practice Address - Street 1:15 HENNING RD OFC
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3749
Practice Address - Country:US
Practice Address - Phone:518-581-3617
Practice Address - Fax:518-581-3688
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY733418163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool