Individual
MS. CARISSA LYNN AGNELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
583 BROADHOLLOW RD, SUITE 202, MELVILLE, NY 11747-5017
(631) 484-8920
Mailing address
16 LARCH ST, LAKE RONKONKOMA, NY 11779-4460
(631) 484-8920
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
851929141
NY
Other
Enumeration date
05/03/2017
Last updated
05/03/2017
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