Provider Demographics
NPI:1114318938
Name:CALISI, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CALISI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3107
Mailing Address - Country:US
Mailing Address - Phone:631-708-6956
Mailing Address - Fax:
Practice Address - Street 1:191 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3107
Practice Address - Country:US
Practice Address - Phone:631-708-6956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2025-03-13
Deactivation Date:2025-01-28
Deactivation Code:
Reactivation Date:2025-02-05
Provider Licenses
StateLicense IDTaxonomies
NY433117363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care