| Doctor Name: | MRS. JESSICA MARIE MENNELLA |
| NPI Number: | 1043676471 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGPCNP-C |
| License Number: | 307519 |
| Business Practice Address: | 510 Hicksville Rd Massapequa, NY - 117581203 |
| Business Phone Number: | 5167952626 |
| Business Fax Number: | |
| Mailing Address: | 510 Hicksville Rd, MASSAPEQUA |
| State: | NY |
| Postal Code: | 117581203 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2016 |
| NPI Last Update Date: | 01/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 307519 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |