Healthcare Provider Details

I. General information

NPI: 1285554782
Provider Name (Legal Business Name): MELISSA GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 LIBERTY AVE
BROOKLYN NY
11208-2922
US

IV. Provider business mailing address

PO BOX 746087
ATLANTA GA
30374-6087
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-6058
  • Fax: 347-808-4985
Mailing address:
  • Phone: 833-804-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15560600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360644
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: