MEDICARE: MRS. AMY MICHELLE MELITA RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	02617196	NY

General Provider Information

NPI Number	:	1669667218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MICHELLE MELITA RN

Provider Business Mailing Address
First Line	:	44 FOREST GLEN DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-2276
Country	:	US
Telephone Number	:	585-720-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 FOREST GLEN DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-2276
Country	:	US
Telephone Number	:	585-720-1671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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