MIA R DERICCO

BAY SHORE, NY
NPI1194407999
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: NY  030197)
Enumeration Date2023-08-02
Last Update Date2023-08-02
Business Address
MIA R DERICCO
270 E MAIN ST
BAY SHORE, NY 11706-8420
Phone number: 631-591-7470
Mailing Address
MIA R DERICCO
39 WOODLAND DR
SMITHTOWN, NY 11787-1847
Phone number: 631-848-2092
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