Provider Demographics
NPI:1679033286
Name:GAUVIN, CAITLIN ALYSE
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ALYSE
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY STONY BROOK HOSPITAL DEPT OF MEDICINE HSC LEVEL 16
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-2058
Mailing Address - Fax:631-444-2493
Practice Address - Street 1:101 NICOLLS RD.
Practice Address - Street 2:HEALTH SCIENCE CENTER T16, ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-637-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine