Provider Demographics
NPI:1285272740
Name:MESSINA, MARIAH LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LEIGH
Last Name:MESSINA
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 1:47 DEEP HOLE RD
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-1431
Mailing Address - Country:US
Mailing Address - Phone:631-466-4294
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN RD STE 2
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1953
Practice Address - Country:US
Practice Address - Phone:631-740-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024517363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty