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

Individual provider Family Medicine Physician · NPI 1013182112

Michelle Marilyn Craddock, ANP is a Nurse Practitioner in Port Jefferson, New York. Graduated from State University of New York at Stony Brook, School of Medicine in 1996, 30 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
30
Trained at
State University of New York at Stony Brook, School of Medicine
Licensed in
NY
In the registry since
2008
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Practice location Address checks out

625 Belle Terre Rd Ste 119 Port Jefferson Medical Assoc
Port Jefferson, NY 11777
Phone: (631) 642-0609
Fax: (631) 642-0588
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence F3325721 (NY)

Record details

NPI number1013182112
Entity typeIndividual (Type 1)
GenderFemale
Credentials ANP
Sole proprietorYes
NPI enumeratedApril 29, 2008
Last updated in NPPESApril 29, 2008

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolSTATE UNIVERSITY OF NEW YORK AT STONY BROOK, SCHOOL OF MEDICINE
Graduated 1996 (30 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Port Jefferson