Provider Demographics
NPI:1760641484
Name:GONCALVES, TERESA M (ANP-C)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:GONCALVES
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Gender:F
Credentials:ANP-C
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Mailing Address - Street 1:500 COMMACK ROAD SUITE 204
Mailing Address - Street 2:WORLD TRADE CENTER HEALTH PROGRAM
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725
Mailing Address - Country:US
Mailing Address - Phone:631-638-0322
Mailing Address - Fax:631-630-6297
Practice Address - Street 1:500 COMMACK ROAD SUITE 204
Practice Address - Street 2:WORLD TRADE CENTER HEALTH PROGRAM
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-638-0322
Practice Address - Fax:631-630-6297
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2017-05-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF303858-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care