Individual
TARA ELIZABETH CARDILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
260 E MIDDLE COUNTRY RD, SMITHTOWN, NY 11787-2982
(631) 444-5437
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
382893
NY
Other
Enumeration date
10/03/2018
Last updated
12/18/2018
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