Provider Demographics
NPI:1902128630
Name:NUNZIATA, PATRICIA ELIZABETH (RPA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:NUNZIATA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 E MONTAUK HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1866
Mailing Address - Country:US
Mailing Address - Phone:631-728-0505
Mailing Address - Fax:631-728-4038
Practice Address - Street 1:34 E MONTAUK HWY STE 4
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1866
Practice Address - Country:US
Practice Address - Phone:631-728-0505
Practice Address - Fax:631-728-4038
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03215501Medicaid
NYA400023563Medicare PIN