Provider Demographics
NPI:1619715430
Name:PELLETTERI, GABRIELLA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ROSE
Last Name:PELLETTERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18 EVELYN LN
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3819
Mailing Address - Country:US
Mailing Address - Phone:631-983-9807
Mailing Address - Fax:
Practice Address - Street 1:16 VAN COTT RD STE 2E
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6519
Practice Address - Country:US
Practice Address - Phone:631-274-0777
Practice Address - Fax:631-274-0777
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant