Mia R. Dericco
Physician Assistant · Bay Shore, NY
UnclaimedNPI 1194407999
- Primary taxonomy
- 363AM0700X
- Enumerated
- 2023-08-02
- Practice location
- Bay Shore, NY
- Last NPPES update
- 2023-08-02
State licenses
- NY · Physician assistant · NPPES self-reportedListed on NPI record
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.