Individual
MS. CHRISTINE ANN FANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15 PARK AVE, BAY SHORE, NY 11706-7381
(631) 581-4400
(631) 581-2564
Mailing address
15 PARK AVE, BAY SHORE, NY 11706-7381
(631) 581-4400
(631) 581-2564
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F333278
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02167655
—
NY
Enumeration date
05/01/2006
Last updated
06/18/2014
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