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MRS. CLAUDIA MIKE PROVENZALE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AGNP

Contact information

Practice address
2500 NESCONSET HWY BLDG 11D, STONY BROOK, NY 11790-2553
(631) 689-7899
(631) 689-7865
Mailing address
2500 NESCONSET HWY, STONY BROOK, NY 11790-2555
(631) 689-7899
(631) 689-7685

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
F310912-01
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
310912
NY

Other

Enumeration date
12/28/2023
Last updated
01/16/2026
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