Provider Demographics
NPI:1114607082
Name:CALIXTE-LYSSE, MARIE S (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:S
Last Name:CALIXTE-LYSSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 STOWE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1628
Mailing Address - Country:US
Mailing Address - Phone:516-313-3381
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 518
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310454-01363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology