Provider Demographics
NPI:1285333435
Name:D'AMBROSIO, RACHELE (NP, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:RACHELE
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:NP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VERA CT
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4532
Mailing Address - Country:US
Mailing Address - Phone:631-742-8754
Mailing Address - Fax:
Practice Address - Street 1:267 E MAIN ST BLDG C
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2847
Practice Address - Country:US
Practice Address - Phone:631-418-8069
Practice Address - Fax:631-656-0470
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health