Provider Demographics
NPI:1063395861
Name:FIORDALISI, CAROLINE CATHERINE (AGNP - C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CATHERINE
Last Name:FIORDALISI
Suffix:
Gender:F
Credentials:AGNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LAURA CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2361
Mailing Address - Country:US
Mailing Address - Phone:631-834-5416
Mailing Address - Fax:
Practice Address - Street 1:5225-15 NESCONSET HWY
Practice Address - Street 2:BUILDING 2
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-509-3516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF312318-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health