Healthcare Provider Details

I. General information

NPI: 1891497756
Provider Name (Legal Business Name): NICOLE VOLINO DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HWY BLDG 2
STONY BROOK NY
11790-2555
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 2
STONY BROOK NY
11790-2555
US

V. Phone/Fax

Practice location:
  • Phone: 631-686-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number344664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: