Provider Demographics
NPI:1538375571
Name:GUCCIARDO, ANU (MSPT)
Entity type:Individual
Prefix:MRS
First Name:ANU
Middle Name:
Last Name:GUCCIARDO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:ANU
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:2 CHATHAM PL
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5412
Mailing Address - Country:US
Mailing Address - Phone:347-678-5603
Mailing Address - Fax:
Practice Address - Street 1:2 CHATHAM PL
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5412
Practice Address - Country:US
Practice Address - Phone:347-678-5603
Practice Address - Fax:866-618-7685
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY762668515OtherDRIVERS LICENSE