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NPI Code Detail

MEDICARE: MIKAYLA NICOLE OSORIO PA-C

MEDICARE: MIKAYLA NICOLE OSORIO PA-C
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
1363AM0700XMedical Physician AssistantMA063404PA

General Provider Information

NPI Number : 1932855822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA NICOLE OSORIO PA-C
Provider Business Mailing Address
First Line : 167 OSBORN ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19128-3716
Country : US
Telephone Number : 570-765-6432
Fax Number :
Provider Business Practice Location Address
First Line : 1412 FAIRMOUNT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-2908
Country : US
Telephone Number : 215-235-9600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2022
Last Update Date : 01/05/2026

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Directions to “ MIKAYLA NICOLE OSORIO PA-C” Practice Location

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