Provider Demographics
NPI:1831411602
Name:CALIXTO, VICTORIA J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:J
Last Name:CALIXTO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:8 WAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1307
Mailing Address - Country:US
Mailing Address - Phone:516-582-3398
Mailing Address - Fax:
Practice Address - Street 1:2920 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 4
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1402
Practice Address - Country:US
Practice Address - Phone:516-735-4949
Practice Address - Fax:516-735-4971
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY336172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily