Healthcare Provider Details

I. General information

NPI: 1326582040
Provider Name (Legal Business Name): CAREY ANN MANCUSO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAREY ANN FACELLO

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 VALLEY BROOK RD STE 300
MC MURRAY PA
15317-3367
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 7
PITTSBURGH PA
15212-5227
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-5588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016920
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103704461
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier13989478
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: