Provider Demographics
NPI:1053573188
Name:SEPE, ELAINE MARIE (NP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:SEPE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:HSC T12-080
Mailing Address - Street 2:SUNY STONY BROOK/NEUROSURGERY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-7925
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:HSC T12-080
Practice Address - Street 2:SUNY STONY BROOK/NEUROSURGERY
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-7925
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY300885363LA2200X
NY381100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics