| Doctor Name: | MARYELLEN ZANGRILLI |
| NPI Number: | 1750729224 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN MS NPP |
| License Number: | 40-401595 |
| Business Practice Address: | 37 Main St Whitesboro, NY - 134921034 |
| Business Phone Number: | 3152645606 |
| Business Fax Number: | 3156248810 |
| Mailing Address: | 37 Main St, WHITESBORO |
| State: | NY |
| Postal Code: | 134921034 |
| Phone Number: | 3152645606 |
| Fax Number: | 3156248810 |
| NPI Enumeration Date: | 06/06/2013 |
| NPI Last Update Date: | 11/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 40-401595 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |