MRS. KELLIANNE TULLEY (NPI# 1760842637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760842637 |
| Entity Type | Individual |
| Full Name | MRS. KELLIANNE TULLEY |
| Credential | PHYSICIAN ASSISTANT |
| Practice Address |
200 Old Country Rd Mineola NY 11501-4235 |
| Mailing Address |
21 Woodbine Ave Merrick NY 11566-3130 |
| Practice Telephone | 5168770977 |
| Practice Fax Number | 5162946861 |
| Mailing Telephone | 5165892539 |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2019-05-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 019479 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
200 OLD COUNTRY RD |
| City | MINEOLA |
| State | NY |
| Zip Code | 11501-4235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457359341 | Joan Aiello | Nurse Practitioner | 200 Old Country Rd, Mineola, NY 11501-4235 | 2005-07-13 |
| 1598323230 | Nyu Langone Hospitals | Clinic/Center | 200 Old Country Rd, Mineola, NY 11501-4235 | 2019-05-29 |
| 1790282044 | David Elsharouny | Student in an Organized Health Care Education/Training Program | 200 Old Country Rd, Mineola, NY 11501-4235 | 2018-04-11 |
| 1376078998 | Nadine Ninivaggi | Student in an Organized Health Care Education/Training Program | 200 Old Country Rd, Mineola, NY 11501-4235 | 2017-04-21 |
| 1740712793 | Navinder Kaur Nat | Student in an Organized Health Care Education/Training Program | 200 Old Country Rd, Suite 460, Mineola, NY 11501-4235 | 2017-03-29 |
| 1447792908 | Heather Gionesi | Nurse Practitioner | 200 Old Country Rd, Suite 278, Mineola, NY 11501-4235 | 2016-11-14 |
| 1609238781 | Benjamin Little | Student in an Organized Health Care Education/Training Program | 200 Old Country Rd, Suite 460, Mineola, NY 11501-4235 | 2016-03-28 |
| 1487016507 | Icahn School of Medicine At Mount Sinai | Internal Medicine | 200 Old Country Rd, Suite 278, Mineola, NY 11501-4235 | 2016-03-28 |
| 1134581465 | Amy Hassan | Student in an Organized Health Care Education/Training Program | 200 Old Country Rd, Suite 460, Mineola, NY 11501-4235 | 2016-03-25 |
| 1477911436 | Winthrop Faculty Medical Affiliates University Faculty Practice Corp | Internal Medicine | 200 Old Country Rd, Suite 450, Mineola, NY 11501-4235 | 2016-02-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710500350 | Steve Abraham Simon | Student in an Organized Health Care Education/Training Program | 222 Station Plaza, Suite 509, Mineola, NY 11501 | 2020-05-18 |
| 1407478167 | Frederick Milton Bosoy | Student in an Organized Health Care Education/Training Program | 259 1st St, Mineola, Ny 11501, Mineola, NY 11501 | 2020-05-15 |
| 1982226130 | Katelyn Anne Fowler | Counselor | [email protected], 410 East Jericho Tpke, Mineola, NY 11501 | 2020-05-11 |
| 1225667819 | New York Dialysis Services, Inc | Clinic/Center | 1 East Jericho Turnpike, Mineola, NY 11501 | 2020-04-06 |
| 1518500032 | Irina Victoria Kushnareva | Social Worker | 126 Saville Rd, Mineola, NY 11501 | 2019-10-28 |
| 1861046336 | Milagros M Matias | Case Manager/Care Coordinator | 39 E. Jericho Turnpike, Mineola, NY 11501 | 2019-08-01 |
| 1154974244 | Bahram Dabiri | Student in an Organized Health Care Education/Training Program | 222 Station Plaza N., Suite 620 Mineola, Mineola, NY 11501 | 2019-07-18 |
| 1972168748 | Nabeel A. Arain | Physician Assistant | 251 1st St., Mineola, NY 11501 | 2019-05-07 |
| 1598328940 | Ramsha Jabbar | Student in an Organized Health Care Education/Training Program | 222 Station Plaza North, Suite 305, Mineola, NY 11501 | 2019-04-20 |
| 1235628850 | Valentyna Erstenyuk | Student in an Organized Health Care Education/Training Program | 222 Station Plaza N, Suite 611, Mineola, NY 11501 | 2018-05-09 |
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| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972168748 | Nabeel A. Arain | Physician Assistant | 251 1st St., Mineola, NY 11501 | 2019-05-07 |
| 1609394436 | Jaime Lynn Moyles | Physician Assistant | 200 Old Country Rd Ste 365, Mineola, NY 11501-4240 | 2017-08-31 |
| 1215191580 | Sreedhar P. Sudnagunta | Physician Assistant | 80 E Jericho Tpke, Suite 100, Mineola, NY 11501-3140 | 2008-07-15 |
| 1881865533 | Abo Suyonov | Physician Assistant | 700 Hickville Road, 259 1st Street, Mineola, NY 11501 | 2008-03-20 |
| 1720268097 | Anjli Kakwani | Physician Assistant | Northwell Gohealth Urgent Care, 50 East Jericho Turnpike, Mineola, NY 11501 | 2007-11-05 |
| 1144419292 | Iosif Galibov | Physician Assistant | 222 Station Plz N Ste 428, Mineola, NY 11501-3819 | 2007-10-15 |
| 1194883066 | Shannon Marie Dipaola | Physician Assistant | 259 First St, Mineola, NY 11501-3957 | 2006-12-04 |
| 1003841560 | Tony Phillips | Physician Assistant | 312 N Pacific St, Mineola, TX 75773-1712 | 2006-07-12 |
| 1154941425 | Russell Broming | Physician Assistant | 259 1st St, Mineola, NY 11501-3957 | 2020-04-16 |
| 1700436136 | Stacey Krasnoff | Physician Assistant | 259 1st St, Mineola, NY 11501-3957 | 2019-09-17 |
| Find all providers in MINEOLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.