Healthcare Provider Details

I. General information

NPI: 1871266080
Provider Name (Legal Business Name): ALISA COFFEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 ROANOKE AVE
RIVERHEAD NY
11901-2706
US

IV. Provider business mailing address

208 ROANOKE AVE
RIVERHEAD NY
11901-2706
US

V. Phone/Fax

Practice location:
  • Phone: 631-284-2565
  • Fax:
Mailing address:
  • Phone: 631-284-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number817900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: