Provider Demographics
NPI:1730266503
Name:NASTASI, JOAN M (CNM)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:NASTASI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OB GYN
Mailing Address - Street 2:HSC 9TH FLOOR, ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8091
Mailing Address - Country:US
Mailing Address - Phone:631-444-3987
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OB GYN
Practice Address - Street 2:HSC 9TH FLOOR, ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8091
Practice Address - Country:US
Practice Address - Phone:631-444-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420798363LW0102X
NYF001460367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02837910Medicaid