Provider Demographics
NPI:1538056817
Name:CIANNILLI, ANALISE B (PA-C)
Entity type:Individual
Prefix:
First Name:ANALISE
Middle Name:B
Last Name:CIANNILLI
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 1:7 S OHIO AVE STE 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6711
Mailing Address - Country:US
Mailing Address - Phone:609-572-8600
Mailing Address - Fax:609-572-8667
Practice Address - Street 1:7 S OHIO AVE STE 1400
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6711
Practice Address - Country:US
Practice Address - Phone:609-572-8600
Practice Address - Fax:609-572-8667
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00949200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant