Provider Demographics
NPI:1437987807
Name:PARAISON, MARIE SANDRA
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SANDRA
Last Name:PARAISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5140
Mailing Address - Country:US
Mailing Address - Phone:631-784-5003
Mailing Address - Fax:
Practice Address - Street 1:1375 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5140
Practice Address - Country:US
Practice Address - Phone:631-784-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348973164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse