Provider Demographics
NPI:1578121463
Name:PACIELLA, MARY ELIZABETH (RN, CNS, NP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:PACIELLA
Suffix:
Gender:F
Credentials:RN, CNS, NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3071
Mailing Address - Country:US
Mailing Address - Phone:631-338-2060
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL
Practice Address - Street 2:101 NICHOLS ROAD SBUH 8S ROOM 142
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7080
Practice Address - Country:US
Practice Address - Phone:631-444-8187
Practice Address - Fax:631-444-6199
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA517819-1163W00000X, 364SA2200X
NYF304070-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health