Healthcare Provider Details

I. General information

NPI: 1790606960
Provider Name (Legal Business Name): ALEXIS MONDELLA PMHNP-BC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 FARR LN
QUEENSBURY NY
12804-1995
US

IV. Provider business mailing address

96 FARR LN
QUEENSBURY NY
12804-1995
US

V. Phone/Fax

Practice location:
  • Phone: 518-321-3192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS MARIA MONDELLA
Title or Position: MANAGING MEMBER
Credential: NP
Phone: 518-321-3192