Provider Demographics
NPI:1952031775
Name:CAPUANO, ALEXA NICOLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLE
Last Name:CAPUANO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HARRISBURG ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4612
Mailing Address - Country:US
Mailing Address - Phone:631-525-1417
Mailing Address - Fax:
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 108105
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2871
Practice Address - Country:US
Practice Address - Phone:631-706-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant