Kaitlyn Maiello-Buckley, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

408688 Issued in NY

Practice address

4655 Nesconset Hwy
Port Jefferson Station, NY 11776-2579

Phone

(631) 317-1814

NPI assigned

Jan 24, 2013

Reactivated

Jul 15, 2026

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788998400000",
    "number": "1396083457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 NESCONSET HWY",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762579",
            "telephone_number": "631-317-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 NESCONSET HWY",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762579",
            "telephone_number": "631-317-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIELLO-BUCKLEY",
        "first_name": "KAITLYN",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "deactivation_date": "2016-10-04",
        "reactivation_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "408688",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "662026",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• M. H. Mandelbaum Orthotic & Prosthetic Services, Inc.
• Allison Michele Maccarello, LCSW
• Kumar Madom, MD
• Michael Magistro, ATC
• Danielle Maher, M.S.
• Romeo Velasco Maloco Jr., OPTICIAN
• Debra Marie Mann, ANP
• Cara Marcy
• Suzette Mariano
• Kathleen Ann Marinelli, M.S., SLP ,CCC-SP

• Psychiatric/Mental Health Nurse Practitioner in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.