Healthcare Provider Details

I. General information

NPI: 1114577673
Provider Name (Legal Business Name): CAROLINE RISDON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FULTON AVE
HEMPSTEAD NY
11550-1030
US

IV. Provider business mailing address

490 W END AVE APT 8E
NEW YORK NY
10024-4331
US

V. Phone/Fax

Practice location:
  • Phone: 516-463-6535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: