Provider Demographics
NPI:1730137365
Name:FEES-RICCIARDI, PHYLLIS (PA-C)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:FEES-RICCIARDI
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 1:400 HOLIDAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2727
Mailing Address - Country:US
Mailing Address - Phone:412-444-0098
Mailing Address - Fax:412-444-0111
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:MERCY AMBULATORY CENTER SUITE 5121
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-444-0098
Practice Address - Fax:412-444-0111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001206-L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical