Provider Demographics
NPI:1508346321
Name:NADELL, LEE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:A
Last Name:NADELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEE-ANNE
Other - Middle Name:
Other - Last Name:KILIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:300 BERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1113
Mailing Address - Country:US
Mailing Address - Phone:516-624-3134
Mailing Address - Fax:
Practice Address - Street 1:2-12 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2025
Practice Address - Country:US
Practice Address - Phone:516-889-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402826-01363LP0808X
NY530706-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse