Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Kathryn Giannico, PA

Individual provider Surgical Physician Assistant · NPI 1154908390

Mary Kathryn Giannico, PA is a Physician Assistant in Port Jefferson, New York. Qualified in 2021, 5 years ago. Practices with John T Mather Memorial Hospital, a 180-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
5
Licensed in
NY
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

75 N Country Rd
Port Jefferson, NY 11777-2119
Phone: (631) 473-1320
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 026500 (NY)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 026500 (NY)

Record details

NPI number1154908390
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 25, 2021
Last updated in NPPESJuly 8, 2025
Certification dateJuly 8, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice John T Mather Memorial Hospital — 180 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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