Amy Beth Gervasio

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

647669-1 Issued in NY

Practice address

644 Wading River Hollow Rd
Middle Island, NY 11953-2136

Phone

(631) 365-9506

NPI assigned

Jul 23, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amy Beth Gervasio Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1487207825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 WADING RIVER HOLLOW RD",
            "city": "MIDDLE ISLAND",
            "state": "NY",
            "postal_code": "119532136",
            "telephone_number": "631-365-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 WADING RIVER HOLLOW RD",
            "city": "MIDDLE ISLAND",
            "state": "NY",
            "postal_code": "119532136",
            "telephone_number": "631-365-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERVASIO",
        "first_name": "AMY",
        "middle_name": "BETH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "647669-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "GERVASIO",
            "middle_name": "BETH",
            "credential": "R.N.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Nurse in Middle Island, NY
• Providers in Middle Island, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.