Provider Demographics
NPI:1912024951
Name:BEAUSOLEIL, LILANDE (NP)
Entity type:Individual
Prefix:
First Name:LILANDE
Middle Name:
Last Name:BEAUSOLEIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EDMUND PELLEGRINO RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-1008
Mailing Address - Country:US
Mailing Address - Phone:631-444-1060
Mailing Address - Fax:631-444-1530
Practice Address - Street 1:3 EDMUND PELLEGRINO RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3816
Practice Address - Country:US
Practice Address - Phone:631-444-1060
Practice Address - Fax:631-444-1530
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304051363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health