MEDICARE: MS. MADONNA CRYSTALEE RODRIGUEZ REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	N32715	NY
2	164W00000X	Licensed Practical Nurse	399150	NY

General Provider Information

NPI Number	:	1821602129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADONNA CRYSTALEE RODRIGUEZ REGISTERED NURSE

Provider Business Mailing Address
First Line	:	132 LONGFELLOW DR
Second Line	:
City	:	MASTIC BEACH
State	:	NY
Zip	:	11951-3016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 LONGFELLOW DR
Second Line	:
City	:	MASTIC BEACH
State	:	NY
Zip	:	11951-3016
Country	:	US
Telephone Number	:	631-575-5851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2020
Last Update Date	:	03/22/2026

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