Provider Demographics
NPI:1841058625
Name:SCHNELLENBACH, CARLEE (RD)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:SCHNELLENBACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 MIDDLE COUNTRY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3503
Mailing Address - Country:US
Mailing Address - Phone:631-737-6343
Mailing Address - Fax:631-738-1226
Practice Address - Street 1:16 ALLEGHENY DR W
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2840
Practice Address - Country:US
Practice Address - Phone:631-294-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse