Active NPI
Maryanna Licata, NP
- Family Nurse Practitioner
- Valley Stream, NY
National Provider Identifier
1336515808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- F331097-1
- Practice address
- 1605 Southern Dr
Valley Stream, NY 11580-1237 - Phone
- (516) 526-2623
- NPI assigned
- Aug 19, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F331097-1 | NY | Primary |
Addresses
Primary practice location
1605 Southern Dr
Valley Stream, NY 11580-1237
Mailing address
1605 Southern Dr
Valley Stream, NY 11580-1237
Phone (516) 526-2623
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F331097-1 | NY | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439942400000",
"number": "1336515808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 SOUTHERN DR",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115801237",
"telephone_number": "516-526-2623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 SOUTHERN DR",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115801237",
"telephone_number": "516-526-2623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICATA",
"first_name": "MARYANNA",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-19",
"last_updated": "2015-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "F331097-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valley Stream, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.