Provider Demographics
NPI:1225889504
Name:MACIAS, GABRIELA ESTEFANIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ESTEFANIA
Last Name:MACIAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 STRAIGHT PATH
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1712
Mailing Address - Country:US
Mailing Address - Phone:516-234-4055
Mailing Address - Fax:
Practice Address - Street 1:420 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3041
Practice Address - Country:US
Practice Address - Phone:631-661-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY353548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily