Provider Demographics
NPI:1871159871
Name:SINGH PESTANO, JULIEAN (ANP)
Entity type:Individual
Prefix:
First Name:JULIEAN
Middle Name:
Last Name:SINGH PESTANO
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:MR
Other - First Name:JULIEAN
Other - Middle Name:
Other - Last Name:SINGH PESTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:261 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 STEWART AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6611
Practice Address - Country:US
Practice Address - Phone:516-289-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309117363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health