Provider Demographics
NPI:1255911251
Name:CHIUSANO, ALEXIS MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:CHIUSANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 RANDY LN
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5125
Mailing Address - Country:US
Mailing Address - Phone:516-304-6861
Mailing Address - Fax:
Practice Address - Street 1:31 MERRICK AVE STE 10
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3406
Practice Address - Country:US
Practice Address - Phone:516-771-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347191-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine