Individual
TYASIA DANIELLE MULLGRAV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 562-0100
Mailing address
16335 130TH AVE APT 2E, JAMAICA, NY 11434-3010
(718) 612-3169
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
826499
NY
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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