Provider Demographics
NPI:1730406158
Name:COLESBAILEY, JUDY PATRICIA
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:PATRICIA
Last Name:COLESBAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:COLESBAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:56 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2028
Mailing Address - Country:US
Mailing Address - Phone:516-623-0781
Mailing Address - Fax:516-623-0781
Practice Address - Street 1:56 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2028
Practice Address - Country:US
Practice Address - Phone:516-623-0781
Practice Address - Fax:516-623-0781
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-24
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401031305R00000X, 101YP2500X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health