Healthcare Provider Details

I. General information

NPI: 1124760517
Provider Name (Legal Business Name): MELISSA ROSE INFOSINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35TH MEDICAL GROUP, UNIT 5024, OBGYN CLINIC/SGCG
APO AP
96319-5024
US

IV. Provider business mailing address

35TH MEDICAL GROUP, UNIT 5024, OBGYN CLINIC/SGCG
APO AP
96319-5024
US

V. Phone/Fax

Practice location:
  • Phone: 315-226-6150
  • Fax:
Mailing address:
  • Phone: 315-226-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101279607
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: