MEDICARE: MIKAYLA MARIE PANCHAL FNP

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	SP032288	PA

General Provider Information

NPI Number	:	1174357487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA MARIE PANCHAL FNP

Provider Business Mailing Address
First Line	:	4029 WINDSFIELD WAY
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-3117
Country	:	US
Telephone Number	:	412-627-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 PARK MANOR BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-4819
Country	:	US
Telephone Number	:	724-773-8950
Fax Number	:

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	09/26/2025

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