Healthcare Provider Details

I. General information

NPI: 1891958237
Provider Name (Legal Business Name): KATHLEEN MARY TAIBI RN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK UNIVERSITY HOSPITAL CARDIOLOGY DIVISION HSC 16 080
STONY BROOK NY
11794-0000
US

IV. Provider business mailing address

STONY BROOK UNIVERSITY HOSPITAL CARDIOLOGY DIVISION HSC 16 080
STONY BROOK NY
11794-0000
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-1066
  • Fax: 631-444-3365
Mailing address:
  • Phone: 631-444-1066
  • Fax: 631-444-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301163-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: