Individual
ASHLEY MANCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
192 ONTARIO AVE, MASSAPEQUA, NY 11758-4027
(347) 436-2208
Mailing address
192 ONTARIO AVE, MASSAPEQUA, NY 11758-4027
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
346478
NY
Other
Enumeration date
09/25/2020
Last updated
09/25/2020
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