Healthcare Provider Details

I. General information

NPI: 1841058625
Provider Name (Legal Business Name): CARLEE SCHNELLENBACH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ALLEGHENY DR W
FARMINGVILLE NY
11738-2840
US

IV. Provider business mailing address

2539 MIDDLE COUNTRY RD STE 4
CENTEREACH NY
11720-3503
US

V. Phone/Fax

Practice location:
  • Phone: 631-294-5467
  • Fax:
Mailing address:
  • Phone: 631-737-6343
  • Fax: 631-738-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number753651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: