Healthcare Provider Details

I. General information

NPI: 1063144467
Provider Name (Legal Business Name): MELISSA LONG NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PRESCOTT ST STE 403
WORCESTER MA
01605-2671
US

IV. Provider business mailing address

7 GOODNOW RD
PRINCETON MA
01541-1602
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-7259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2333721
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2333721
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2333721
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: