Provider Demographics
NPI:1740952332
Name:MASTRACCIO, RICHELLE ASHLEY (FNP)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:ASHLEY
Last Name:MASTRACCIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RICHELLE
Other - Middle Name:ASHLEY
Other - Last Name:CIMMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8 SOUTHWOODS BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2573
Mailing Address - Country:US
Mailing Address - Phone:518-434-1446
Mailing Address - Fax:518-434-0806
Practice Address - Street 1:8 SOUTHWOODS BLVD STE 9
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12211-2554
Practice Address - Country:US
Practice Address - Phone:518-434-1446
Practice Address - Fax:518-434-0806
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348527363L00000X
NY661440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse