Individual provider · Type 1 NPI
Claudia Mike Provenzale, AGNP
Adult Health Nurse Practitioner · Stony Brook, NY
NPI number
1245009547
Active
Practice location
2500 Nesconset Hwy Bldg 11D
Stony Brook, NY 11790-2553
Fax (631) 689-7865
Mailing address
2500 Nesconset Hwy
Stony Brook, NY 11790-2555
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Health Nurse Practitioner Primary | 363LA2200X | 310912 (NY) |
| Internal Medicine Physician | 207R00000X | F310912-01 (NY) |
Adult Health Nurse Practitioner: Definition to come...
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About NPI 1245009547
Claudia Mike Provenzale, AGNP's National Provider Identifier is 1245009547, issued on Dec 28, 2023. The primary taxonomy on file is Adult Health Nurse Practitioner (363LA2200X), and the practice location is in Stony Brook, NY. The record was last updated on Jan 16, 2026.