Healthcare Provider Details

I. General information

NPI: 1730094434
Provider Name (Legal Business Name): CHARLOTTE BEACH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE JOY COSTANTINO FNP-BC

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 STRAWBERRY LN
CLAYTON NY
13624-1409
US

IV. Provider business mailing address

37393 BALD ROCK RD
CLAYTON NY
13624-3323
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-2094
  • Fax:
Mailing address:
  • Phone: 315-686-2094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: