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

Kelly Ann Antimisiaris

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1265213797

Kelly Ann Antimisiaris is a Nurse Practitioner in Massapequa, New York. Qualified in 2023, 3 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023

Practice location Address checks out

5550 Merrick Rd
Massapequa, NY 11758-6238
Phone: (631) 773-1096
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 · Licence 405343 (NY)

Record details

NPI number1265213797
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 10, 2023
Last updated in NPPESOctober 10, 2023
Certification dateOctober 10, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Massapequa