| Doctor Name: | MS. EMILIA THEODATE |
| NPI Number: | 1255616983 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 22560607 |
| Business Practice Address: | 5 Birch St Central Islip, NY - 117223101 |
| Business Phone Number: | 6312316919 |
| Business Fax Number: | |
| Mailing Address: | 5 Birch St, CENTRAL ISLIP |
| State: | NY |
| Postal Code: | 117223101 |
| Phone Number: | 6312316919 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2011 |
| NPI Last Update Date: | 10/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WS0200X |
| License Number: | 22560607 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |