Healthcare Provider Details

I. General information

NPI: 1831925403
Provider Name (Legal Business Name): ALIEA SHAFFIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E MAIN ST STE 9
SMITHTOWN NY
11787-2831
US

IV. Provider business mailing address

957 DOWNING RD
VALLEY STREAM NY
11580-1508
US

V. Phone/Fax

Practice location:
  • Phone: 631-366-2333
  • Fax:
Mailing address:
  • Phone: 516-524-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number355125
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: