Individual
KATHLEEN FANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
Mailing address
77 PACIFIC AVE, DEER PARK, NY 11729-3141
(516) 317-4169
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
F433058-01
NY
Other
Enumeration date
11/16/2024
Last updated
03/20/2025
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