Provider Demographics
NPI:1497277305
Name:RIELLO, NICOLE JEAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JEAN
Last Name:RIELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-1208
Mailing Address - Country:US
Mailing Address - Phone:845-825-7076
Mailing Address - Fax:
Practice Address - Street 1:2904 ROUTE 6 STE 1
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3810
Practice Address - Country:US
Practice Address - Phone:845-355-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant