Jacqueline Sommer Colalillo
Jacqueline Sommer Colalillo is a Physician Assistant in Lake Grove, New York. Qualified in 2025, 1 year ago. Practices with Stony Brook Urology University Faculty Practice Corporation, a 37-clinician group and accepts Medicare assignment.
- Years since qualifying
- 1
- In the registry since
- 2025
Practice location Address checks out
4 Smith Haven Mall Ste 110Lake Grove, NY 11755-1219
Phone: (631) 444-6270
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Physician Assistant (primary) | Taxonomy 363A00000X |
|---|
Record details
| NPI number | 1104701671 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | August 6, 2025 |
| Last updated in NPPES | August 25, 2025 |
| Certification date | August 25, 2025 |
| Mailing address | 4 Smith Haven Mall Ste 110, Lake Grove, NY 11755-1219 |
Medicare enrollment
| Medicare specialty | PHYSICIAN ASSISTANT |
|---|---|
| Medical school | OTHER |
| Graduated | 2025 (1 years in practice) |
| Group practice | Stony Brook Urology University Faculty Practice Corporation — 37 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
| Practice locations | 2 on file with Medicare |
Other providers in Lake Grove
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Julio C Almeyda, PHYSICIANASSISTANT
2780 Middle Country Rd Suit 140, Lake Grove, NY 11755-2124 · (631) 580-1000
-
MS. Emily Rose Farina, PA-C
63 Sarah Dr, Lake Grove, NY 11755-2219 · (631) 561-5444
-
Patrick J Lee
12 English Ivy Ln, Lake Grove, NY 11755-1847 · (559) 321-3873
-
Anum Mahmood, RPA-C
4 Smith Haven Mall, Lake Grove, NY 11755-1219 · (631) 444-1993
-
Matthew Merensky, PA-C
4 Smith Haven Mall Ste 103, Lake Grove, NY 11755-1219 · (631) 444-4233