Individual
KELLY WENZEL SCICUTELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(631) 742-3536
Mailing address
300 COMMUNITY DR, MANHASSET, NY 11030-3816
(516) 562-0100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
017346
NY
Other
Enumeration date
01/31/2014
Last updated
06/09/2022
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