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Mia R Dericco
Medical Physician Assistant in Bay Shore, New York
NPI 1194407999

Mia R Dericco is a Medical Physician Assistant based in Smithtown, NY and is specialized in Medical. Mia R Dericco practices in Bay Shore, NY. The NPI Number for Mia R Dericco is 1194407999 and holds a License No. 030197 (New York).

The current practice location address for Mia R Dericco is 270 E Main St, Bay Shore, NY and can be reached out via phone at 631-591-7470.

Location: 270 E Main St, Bay Shore, NY, 11787-1847
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1194407999
Provider Name
Mia R Dericco
Credential
Provider Entity Type
Individual
Gender
Female
Address
270 E Main St, Bay Shore, NY, 11787-1847
Phone Number
631-591-7470
Fax Number
Provider Enumeration Date
08/02/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
270 E Main St
City
Bay Shore
State
New York
Zip
11706-8420
Phone Number
631-591-7470
Fax Number
person
Provider Business Mailing Address Details
Address
270 E Main St
City
Bay Shore
State
New York
Zip
11706-8420
Phone Number
631-591-7470
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
030197 (New York)
Definition
Definition to come...
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