Individual
AUDRACY GENIA MASSAKIDI MBOUSSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4400 VESTAL PKWY E, BINGHAMTON, NY 13902
(607) 296-3072
Mailing address
4400 VESTAL PKWY E, BINGHAMTON, NY 13902
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
F407919
NY
163W00000X
Registered Nurse
Primary
NA
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F407919
NY
Other
Enumeration date
01/21/2026
Last updated
04/14/2026
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