# MALLORY K BELLISSIMO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1255640074
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10513 | GA | Yes |
| 363A00000X | Physician Assistant | PA60385985 | WA | — |

## Other

- **Enumeration date:** 09/28/2010
- **Last updated:** 11/07/2023