# NURSE PRACTITIONER INFANT AND CHILD HEALTHCARE, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Michele Kelly LPNP, NPP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568958700
- **Authorized official:** MS. MICHELE A. TRIOLO LPNP, NPP (PRESIDENT)
- **Authorized official phone:** (631) 235-2401

## Contact information

- **Practice address:** 1227 MAIN STREET, SUITE 201, PORT JEFFERSON, NY 11777
- **Practice address phone:** (631) 235-2401
- **Practice address fax:** (631) 689-3993
- **Mailing address:** PO BOX 631, MILLER PLACE, NY 11764
- **Mailing address phone:** (631) 235-2401
- **Mailing address fax:** (631) 689-3993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | 380749 | NY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F-400866-1 | NY | Yes |

## Other

- **Enumeration date:** 07/10/2018
- **Last updated:** 07/10/2018