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

Individual provider Physician Assistant · NPI 1356975411

Mimma Alessandra Mazzola, PA-C is a Physician Assistant in Melville, New York. Qualified in 2020, 6 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in New York.

Years since qualifying
6
Licensed in
NY
In the registry since
2020
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

510 Broadhollow Rd
Melville, NY 11747-3671
Phone: (631) 424-3600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 259 1st St, Mineola, NY 11501-3957 — (516) 663-0333

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 025302 (NY)

Record details

NPI number1356975411
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedFebruary 27, 2020
Last updated in NPPESMay 7, 2024
Certification dateMay 7, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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