Provider Demographics
NPI:1902817083
Name:CALDWELL, SUNDAY JEAN (NP)
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:JEAN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUNDAY
Other - Middle Name:
Other - Last Name:CAMPOLO-ATHANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54 GNARLED HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-560-1626
Mailing Address - Fax:631-444-7502
Practice Address - Street 1:GOOD SAMARITAN HOSPITAL MEDICAL CENTER
Practice Address - Street 2:1000 MONTAUK HWY
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-376-3417
Practice Address - Fax:631-376-3483
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301526363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health