Healthcare Provider Details

I. General information

NPI: 1528253101
Provider Name (Legal Business Name): HEATHER CALENDRILLO PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

IV. Provider business mailing address

655 DEER PARK AVE
BABYLON NY
11702-1314
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-2160
  • Fax: 631-321-2186
Mailing address:
  • Phone: 631-321-2160
  • Fax: 631-321-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number381910
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: