Basic Information
| Provider Information | |||||||||
| NPI: | 1750024949 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | POLICASTRO | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 CALICO TREE RD | ||||||||
| Address2: | |||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117882623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316643110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 181 N. BELLE MEAD ROAD | ||||||||
| Address2: | |||||||||
| City: | EAST SETAUKET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314442599 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2022 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F383285-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.