Healthcare Provider Details

I. General information

NPI: 1801054226
Provider Name (Legal Business Name): CHRYSTYNE OLIVIERI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MAIN ST STE 2B
NORTHPORT NY
11768-1790
US

IV. Provider business mailing address

325 MAIN ST STE 2B
NORTHPORT NY
11768-1790
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-2400
  • Fax: 631-751-8323
Mailing address:
  • Phone: 631-833-3636
  • Fax: 949-695-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberF334603
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF334603
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: