Healthcare Provider Details

I. General information

NPI: 1134712938
Provider Name (Legal Business Name): MELISSA SANTOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 172ND ST
BRONX NY
10460-5802
US

IV. Provider business mailing address

117 W 124TH ST
NEW YORK NY
10027-4920
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2200
  • Fax: 718-328-7493
Mailing address:
  • Phone: 212-949-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number721981
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF349266
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: