Individual
MICHELLE PENNASILICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
410 W 24TH ST APT 5K, NEW YORK, NY 10011-1304
(917) 733-4061
Mailing address
410 W 24TH ST APT 5K, NEW YORK, NY 10011-1304
(917) 733-4061
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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