Provider Demographics
NPI:1780210112
Name:MIGNUCCI, CAMILLA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:MIGNUCCI
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 1:6601 SUDBURY RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7534
Mailing Address - Country:US
Mailing Address - Phone:972-978-0606
Mailing Address - Fax:
Practice Address - Street 1:425 E 67TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6004
Practice Address - Country:US
Practice Address - Phone:800-525-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology