| Doctor Name: | MS. LISA MICHELLE HODGE-SCELSA |
| NPI Number: | 1104922244 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | F301157 |
| Business Practice Address: | 77 Medford Ave Route 112 Patchogue, NY - 117721281 |
| Business Phone Number: | 6317584444 |
| Business Fax Number: | 6317581984 |
| Mailing Address: | 280 Montauk Hwy, Po Box 9182 BAY SHORE |
| State: | NY |
| Postal Code: | 117068403 |
| Phone Number: | 6317584444 |
| Fax Number: | 6317581984 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 08/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F301157 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |