Healthcare Provider Details

I. General information

NPI: 1386506905
Provider Name (Legal Business Name): CAITLIN COYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 NY-25A
SMITHTOWN NY
11787
US

IV. Provider business mailing address

27 PINE ST
SAYVILLE NY
11782-3207
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: