Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mariella R Scrudato, PA-C

Individual provider Physician Assistant · NPI 1407402126

Mariella R Scrudato, PA-C is a Physician Assistant in Valley Stream, New York. Works from 3 locations. Licensed in New York.

Licensed in
NY
In the registry since
2019
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

65 Roosevelt Ave
Valley Stream, NY 11581-1151
Phone: (516) 622-3490
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 11412 Beach Channel Dr, Rockaway Park, NY 11694-2212 — (718) 474-3375
  • 167 E Merrick Rd, Valley Stream, NY 11580-5925 — (516) 825-3030

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 024647 (NY)

Record details

NPI number1407402126
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 19, 2019
Last updated in NPPESJuly 20, 2023
Certification dateJuly 20, 2023

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