Mindi Lyn Mancuello, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110004770 Issued in VA

Practice address

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456

Phone

(757) 507-1000

NPI assigned

Jun 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Mindi Lyn Morgan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Saint Raphael Faculty Physicians

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1932138138

  Physician Assistant

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550448000000",
    "number": "1659313336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 REDGATE AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071515",
            "telephone_number": "757-668-7874",
            "fax_number": "757-668-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 GLENN MITCHELL DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23456",
            "telephone_number": "757-507-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 Kingsley Ave",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320735148",
            "country_code": "US",
            "telephone_number": "904-639-8500",
            "fax_number": "954-858-0404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 Kempsville Rd",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235023920",
            "country_code": "US",
            "telephone_number": "757-261-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Childrens Ln",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071910",
            "country_code": "US",
            "telephone_number": "757-668-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANCUELLO",
        "first_name": "MINDI",
        "middle_name": "LYN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2019-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104369",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001618",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110004770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182517415A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2929279-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINDI",
            "last_name": "MORGAN",
            "middle_name": "LYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.