Healthcare Provider Details

I. General information

NPI: 1083790364
Provider Name (Legal Business Name): CAROLE RANDI CAPPARELLI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ROUTE 25A
SMITHTOWN NY
11787-1348
US

IV. Provider business mailing address

118 STETHEM DR
CENTEREACH NY
11720-4082
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3000
  • Fax:
Mailing address:
  • Phone: 631-580-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302949-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: