Provider Demographics
NPI:1538368782
Name:SWEENEY, STEPHEN W (RN)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CANDEE AVE
Mailing Address - Street 2:APT. 6G
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 CANDEE AVE
Practice Address - Street 2:APT. 6G
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3000
Practice Address - Country:US
Practice Address - Phone:631-241-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY580471-1163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681254Medicaid