Provider Demographics
NPI:1982055471
Name:MEDUGNO, MARISA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:NICOLE
Last Name:MEDUGNO
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 EAST MAIN STREET
Mailing Address - Street 2:ACUTE CARE SURGERY / TRAUMA
Mailing Address - City:BAYSHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-968-3895
Mailing Address - Fax:
Practice Address - Street 1:301 EAST MAIN STREET
Practice Address - Street 2:ACUTE CARE SURGERY / TRAUMA
Practice Address - City:BAYSHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-968-3895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2018-03-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical