Doctor profile · Federal record
Dr. Mia Dericco
Medical Physician Assistant (CMS: Physician Assistant) · Bay Shore, NY
- NPI 1194407999
- Accepts Medicare
- 3 yrs in practice
- Female
- Group practice
- No sanctions
Practice & contact
- Primary practice
-
270 E Main St
Bay Shore, NY 117068420
(631) 591-7470 - Mailing address
-
39 Woodland Dr
Smithtown, NY 117871847
Credentials & registration
- NPI registered
- August 2023 — 3 yrs on file
- Year of graduation
- 2023 — 3 yrs since
- Specialty taxonomy
- 363AM0700X — NUCC code
- State license (1)
- New York #030197
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1194407999. Last verified May 11, 2026.Open Payments
Industry payments received
All-time total
$28
Transactions
1
Manufacturers
1
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| Medtronic, INC. | 1 | $27.52 |
By nature of payment
Hospital affiliations
Frequently asked questions
What is Dr. Mia Dericco's medical specialty?
Dr. Mia Dericco practices Medical Physician Assistant in Bay Shore, NY.
Where does Dr. Mia Dericco practice?
Dr. Mia Dericco practices at 270 E Main St, Bay Shore, NY 117068420. Office phone: 6315917470.
What is Dr. Mia Dericco's NPI?
Dr. Mia Dericco's National Provider Identifier (NPI) is 1194407999, issued by NPPES.
Does Dr. Mia Dericco accept Medicare assignment?
Yes. Dr. Mia Dericco accepts Medicare assignment, meaning Medicare-allowed amounts are accepted as full payment for covered services.