MEDICARE: MRS. CLAUDIA MIKE PROVENZALE AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	310912	NY
2	207R00000X	Internal Medicine Physician	F310912-01	NY

General Provider Information

NPI Number	:	1245009547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLAUDIA MIKE PROVENZALE AGNP

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2555
Country	:	US
Telephone Number	:	631-689-7899
Fax Number	:	631-689-7685

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 11D
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2553
Country	:	US
Telephone Number	:	631-689-7899
Fax Number	:	631-689-7865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	01/16/2026

Similar Medicare Providers

1154432433 — DR. ELENI BACOLA M.D.
Practice Location Address:

2500 NESCONSET HWY BLDG 10D
STONY BROOK, NY
11790-2553

Practice Phone: 631-751-0600
Practice Fax: 631-751-6526

1598860967 — CHING-HUI WU M.D.
Practice Location Address:

2500 NESCONSET HWY , BLDG 12C
STONY BROOK, NY
11790-2553

Practice Phone: 163-175-1218
Practice Fax:

1427198076 — DR. FANGQIN LI MD
Practice Location Address:

2500 NESCONSET HWY BLDG 12C
STONY BROOK, NY
11790-2553

Practice Phone: 631-751-5550
Practice Fax: 631-689-5472

1629113329 — JOSEPH J LACARRUBBA DDS
Practice Location Address:

2500 NESCONSET HWY , SUITE 11 A
STONY BROOK, NY
11790-2553

Practice Phone: 631-751-7171
Practice Fax: 631-751-7530

1578766440 — MRS. MAUREEN ANNE GRAUER MT
Practice Location Address:

2500 NESCONSET HWY BLDG 12A
STONY BROOK, NY
11790-2553

Practice Phone: 631-689-0049
Practice Fax:

1578724381 — NATALIA CRISTINA FLORES M.D.
Practice Location Address:

2500 ROUTE 347 BLDG 10A
STONY BROOK, NY
11790-2553

Practice Phone: 631-751-0934
Practice Fax:

Directions to “ MRS. CLAUDIA MIKE PROVENZALE AGNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.