Provider Demographics
NPI:1457651200
Name:RICCIARDO, BASILIA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:BASILIA
Middle Name:
Last Name:RICCIARDO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:536 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1716
Practice Address - Country:US
Practice Address - Phone:516-671-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002955363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical