MEDICARE: ALYSSA LYNN MULLANE

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	F358113-01	NY

General Provider Information

NPI Number	:	1447120738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA LYNN MULLANE

Provider Business Mailing Address
First Line	:	228 ALBOURNE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 ALBOURNE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3033
Country	:	US
Telephone Number	:	917-557-1364
Fax Number	:

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

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/11/2025

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