Provider Demographics
NPI:1558897231
Name:MULLINGS, MATTHEW EVANS (CAA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EVANS
Last Name:MULLINGS
Suffix:
Gender:M
Credentials:CAA
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Mailing Address - Street 1:68 S SERVICE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:
Practice Address - Street 1:7900 FANNIN ST STE 1750
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2959
Practice Address - Country:US
Practice Address - Phone:713-790-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017016395367H00000X
TX24570351367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant