Provider Demographics
NPI:1437447455
Name:PARADISE, CAROL EUGENIA (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:EUGENIA
Last Name:PARADISE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-9120
Mailing Address - Fax:631-638-1692
Practice Address - Street 1:23 S HOWELL AVE STE G
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720
Practice Address - Country:US
Practice Address - Phone:631-638-1672
Practice Address - Fax:631-638-1692
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2019-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY014789-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant