MEDICARE: MRS. MARYELLEN D'AMBROSIO MS,PMHNP,BC

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	F400855	NY

General Provider Information

NPI Number	:	1700813292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYELLEN D'AMBROSIO MS,PMHNP,BC

Provider Business Mailing Address
First Line	:	47 KATHLEEN LN
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-3626
Country	:	US
Telephone Number	:	914-241-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 COMMERCE ST
Second Line	:	SUITE 300
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4428
Country	:	US
Telephone Number	:	914-245-0437
Fax Number	:	914-245-0438

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	11/04/2008

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