Individual
MS. PHYLLIS MACCHIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
Mailing address
PO BOX 5120, MILLER PLACE, NY 11764-1102
(631) 331-1546
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F300768-1 NP
NY
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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