MEDICARE: JESSICA MASTANDREA 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	F346380-01	NY

General Provider Information

NPI Number	:	1568063543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MASTANDREA FNP

Provider Business Mailing Address
First Line	:	11 SPRAGUE CT
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5115
Country	:	US
Telephone Number	:	845-853-2826
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-6400
Fax Number	:

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

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	03/05/2026

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