Healthcare Provider Details

I. General information

NPI: 1073444758
Provider Name (Legal Business Name): RACHEL VICTORIA MERCORELLA REGENSBURG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL VICTORIA MERCORELLA PMHNP

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

34 NELSON AVE
BLUE POINT NY
11715-1228
US

V. Phone/Fax

Practice location:
  • Phone: 631-942-0181
  • Fax:
Mailing address:
  • Phone: 631-942-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number797655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: