Individual
ALICIA TAMARA PORTUONDO-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
189 WHEATLEY RD, GLEN HEAD, NY 11545-2641
(516) 686-4400
Mailing address
189 WHEATLEY RD, GLEN HEAD, NY 11545-2641
(516) 686-4400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
590004
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F402195-1
NY
Other
Enumeration date
06/17/2010
Last updated
12/19/2018
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