Provider Demographics
NPI:1407194855
Name:CALIENDO, ALISA (ANP, MSN, BSN, RN)
Entity Type:Individual
Prefix:MISS
First Name:ALISA
Middle Name:
Last Name:CALIENDO
Suffix:
Gender:F
Credentials:ANP, MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N COUNTRY RD
Mailing Address - Street 2:201
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2161
Mailing Address - Country:US
Mailing Address - Phone:631-331-0200
Mailing Address - Fax:
Practice Address - Street 1:70 N COUNTRY RD
Practice Address - Street 2:201
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2161
Practice Address - Country:US
Practice Address - Phone:631-331-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306281363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health