Healthcare Provider Details

I. General information

NPI: 1275405557
Provider Name (Legal Business Name): ABIGAIL SZYDZIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 KEMPSTER AVE
BAY SHORE NY
11706-8915
US

IV. Provider business mailing address

21 KEMPSTER AVE
BAY SHORE NY
11706-8915
US

V. Phone/Fax

Practice location:
  • Phone: 631-252-1438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF312561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: