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General NPI Number Information
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NPI Number | 1740952332
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Entity Type | Individual
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Provider Name | RICHELLE ASHLEY MASTRACCIO FNP
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Gender | Female
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 8 SOUTHWOODS BLVD STE 9
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City | ALBANY
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State | NY
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Zip | 12211-2554
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Country | US
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Telephone | 518-434-1446
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Fax | 518-434-0806
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Provider Business Mailing Address
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Address Line | 8 SOUTHWOODS BLVD STE 9
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City | ALBANY
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State | NY
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Zip | 12211-2573
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Country | US
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Telephone | 518-434-1446
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Fax | 518-434-0806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 348527
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 661440
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License Number State | NY
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