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

Individual provider Physician Assistant · NPI 1548882608

Taylor Marie Iannicelli, PA-C is a Physician Assistant in Staten Island, New York. Qualified in 2020, 6 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group, works from 2 locations and accepts Medicare assignment.

Years since qualifying
6
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

1 Campus Rd
Staten Island, NY 10301-4479
Phone: (718) 390-3100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 522 Van Sicklen St, Brooklyn, NY 11223-4613 — (917) 600-5099

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1548882608
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 12, 2020
Last updated in NPPESJuly 13, 2020
Certification dateJuly 13, 2020

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)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Staten Island