Nyquellet Carolyn Blake, RN
Individual provider Active NPI Registered Nurse · Selden, NY
NPI 1114896271 · NPPES record last updated Nov 7, 2025
Key facts
- NPI
- 1114896271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- N0561801 (NY)
- Practice address
- 556 Hawkins Rd
Selden, NY 11784-2035 - Phone
- (914) 441-4903
- NPI assigned
- Nov 5, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N0561801 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | N0561801 | NY | Yes |
Addresses
Primary practice location
556 Hawkins Rd
Selden, NY 11784-2035
Mailing address
556 Hawkins Rd
Selden, NY 11784-2035
Phone (914) 441-4903
Other providers in Selden, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.