MANDY M CICCARELLO PA
NPI 1841368479
Physician Assistant - Medical in Lutz, FL

Q: What is Mandy Ciccarello's NPI number?

The NPI number for Mandy Ciccarello is 1841368479. It was assigned to this individual provider in the NPPES registry on December 1, 2006.

Q: What is Mandy Ciccarello's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Mandy Ciccarello was last updated on October 16, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 01, 2006PECOS Enrolled

24420 STATE ROAD 54, LUTZ, FL 33559(813) 909-1700(813) 909-2143 Get Directions Write a Review

NPPES record last updated: October 16, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Mandy M Ciccarello Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MANDY M CICCARELLO PA (NPI 1841368479) is an individual medical provider in Lutz, Florida, licensed in Florida (PA9103828) and active in the NPI registry since December 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1841368479

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMANDY M CICCARELLOCredential: PA

Location Address24420 STATE ROAD 54Lutz, FL 33559-7303

Mailing Address24420 State Road 54Lutz, FL 33559-7303 · (813) 909-1700 · Fax (813) 909-2143

Phone(813) 909-1700

Fax(813) 909-2143

Sole ProprietorNo

Enumeration DateDecember 1, 2006

Last NPPES UpdateOctober 16, 2024

NPPES CertifiedOctober 16, 2024

✔ NPI 1841368479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in FL · PA9103828

24420 STATE ROAD 54, Lutz, FL 33559

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mandy M Ciccarello Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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