Provider Demographics
NPI:1730050931
Name:MIRABELLA, ALEKSIA (BA OF SCIENCE)
Entity type:Individual
Prefix:
First Name:ALEKSIA
Middle Name:
Last Name:MIRABELLA
Suffix:
Gender:F
Credentials:BA OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 PORTION RD STE 21
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-4207
Mailing Address - Country:US
Mailing Address - Phone:631-320-1599
Mailing Address - Fax:
Practice Address - Street 1:1075 PORTION RD STE 21
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-4207
Practice Address - Country:US
Practice Address - Phone:631-320-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty