Healthcare Provider Details

I. General information

NPI: 1679436240
Provider Name (Legal Business Name): KASEY NIGRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 LAKE POINTE CIR
MIDDLE ISLAND NY
11953-2009
US

IV. Provider business mailing address

191 LAKE POINTE CIR
MIDDLE ISLAND NY
11953-2009
US

V. Phone/Fax

Practice location:
  • Phone: 631-747-2756
  • Fax:
Mailing address:
  • Phone: 631-747-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: