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General NPI Number Information
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NPI Number | 1700623907
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Entity Type | Individual
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Provider Name | TITSANIA ELIZABETH SUPERSAD COLEY AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 25 SCHOENFELD BLVD
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City | PATCHOGUE
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State | NY
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Zip | 11772-2982
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Country | US
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Telephone | 631-807-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 372 ISLIP AVE
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City | ISLIP
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State | NY
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Zip | 11751-1808
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Country | US
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Telephone | 631-277-8804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 311883
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License Number State | NY
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