Individual
MARYSTELLA ANIDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2906 S 20TH ST, MILWAUKEE, WI 53215-3732
(414) 672-1353
Mailing address
1032 S CESAR E CHAVEZ DR, MILWAUKEE, WI 53204-2203
(414) 672-1353
(262) 408-5094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8744-23
WI
363A00000X
Physician Assistant
Primary
—
IN
363AM0700X
Medical Physician Assistant
8744-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/01/2022
Last updated
06/24/2026
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