Provider Demographics
NPI:1437305562
Name:GAYLE, NATALIE SIMONE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:SIMONE
Last Name:GAYLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:SIMONE
Other - Last Name:GAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:100 DUFFY AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3636
Mailing Address - Country:US
Mailing Address - Phone:631-245-0089
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1019
Practice Address - Country:US
Practice Address - Phone:631-761-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY467848-1163W00000X
NY403749363L00000X
NYF403749-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY403749OtherNURSE PRACTITIONER PSYCHIATRY LICENSE #
NY1437305562Medicaid