MEDICARE: CASSIDY MANGANO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F358593-01	NY

General Provider Information

NPI Number	:	1154277028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY MANGANO

Provider Business Mailing Address
First Line	:	2974 HEMLOCK PL
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2974 HEMLOCK PL
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4610
Country	:	US
Telephone Number	:	516-458-6108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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Directions to “ CASSIDY MANGANO ” Practice Location

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