Michelle L Ceo, C.P.N.P.

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

381993 Issued in NY

Practice address

HSC T19-068 Nichols Rd.
Stony Brook, NY 11794

Phone

(631) 444-2045

Fax

(631) 444-8862

NPI assigned

Jan 4, 2009

Sex

Female

Sole proprietor

Yes

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

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: michelle.ceo@direct.stonybrookmedicine.edu

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

{
    "created_epoch": "1231027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1578709119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "HSC T19-068 NICHOLS RD.",
            "address_2": "STONY BROOK UNIVERSITY MEDICAL CENTER",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-444-2045",
            "fax_number": "631-444-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HSC T19-068 NICHOLS RD.",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11794",
            "telephone_number": "631-444-2045",
            "fax_number": "631-444-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEO",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "C.P.N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-04",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F381993",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "381993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cynthia Ann Cervoni, PHD
• Mason Chacko, M.D.
• Steven Chacko, MD

• Pediatric Nurse Practitioner in Stony Brook, NY
• Providers in Stony Brook, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.