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

Lissa Boileau

Individual provider Registered Nurse · NPI 1174840367

Lissa Boileau is a Nurse Practitioner in Ronkonkoma, New York. Qualified in 2024, 2 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in New York.

Years since qualifying
2
Licensed in
NY
In the registry since
2010
Specialties on file
2
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Practice location Address checks out

2 The Plz
Ronkonkoma, NY 11779-5849
Phone: (631) 676-2765
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 406771 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 22609284 (NY)

Record details

NPI number1174840367
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedApril 27, 2010
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing address2100 Nesconset Hwy # 1060, Stony Brook, NY 11790-3503

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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