MEDICARE: MARY S RICCELLI NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0004954	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407871643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY S RICCELLI NP

Provider Business Mailing Address
First Line	:	488 PAWLING AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-5832
Country	:	US
Telephone Number	:	720-317-9460
Fax Number	:	877-268-5001

Provider Business Practice Location Address
First Line	:	10290 S PROGRESS WAY STE 208
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-9056
Country	:	US
Telephone Number	:	720-317-9460
Fax Number	:	877-268-5001

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	05/14/2021

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