Provider Demographics
NPI:1003469032
Name:GARDELLA, MARIA TERESA (FAMILY NP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:GARDELLA
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 FIRE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-4415
Mailing Address - Country:US
Mailing Address - Phone:516-669-6677
Mailing Address - Fax:
Practice Address - Street 1:NORTHWELL HEALTH
Practice Address - Street 2:440 E MAIN STREET
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-414-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3440191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily