Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Champion Community Partners, LLC

Organization Psychiatric/Mental Health Nurse Practitioner · NPI 1922989144

Champion Community Partners, LLC is a Psychiatric/Mental Health Nurse Practitioner in Massapequa Park, New York. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

5100 Sunrise Hwy
Massapequa Park, NY 11762-2935
Phone: (631) 696-4357
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X

Record details

NPI number1922989144
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tracey Wallace — Vp Ops · (631) 696-4357
NPI enumeratedSeptember 12, 2025
Last updated in NPPESSeptember 12, 2025
Certification dateSeptember 12, 2025
Mailing address1377 Motor Pkwy Ste 102, Islandia, NY 11749-5249

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