Healthcare Provider Details

I. General information

NPI: 1609918432
Provider Name (Legal Business Name): CATHERINE ANN PARADISO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/20/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE RD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

800 AXINN AVE
GARDEN CITY NY
11530-2139
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-420-2718
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303278-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401690-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: