Provider Demographics
NPI:1174702476
Name:STAIANO, DONALD D
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:D
Last Name:STAIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2111
Mailing Address - Country:US
Mailing Address - Phone:631-369-9028
Mailing Address - Fax:631-369-9064
Practice Address - Street 1:765 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2111
Practice Address - Country:US
Practice Address - Phone:631-369-9028
Practice Address - Fax:631-369-9064
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026875-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist