Provider Demographics
NPI:1528533445
Name:MINELLI, ANTHONY RONALD (PA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RONALD
Last Name:MINELLI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-626-1771
Mailing Address - Fax:
Practice Address - Street 1:101 NICHOLLS ROAD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-7875
Practice Address - Fax:631-444-8947
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-07
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant