Healthcare Provider Details

I. General information

NPI: 1528084688
Provider Name (Legal Business Name): MELISSA TAYLOR-BOBB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 E FORDHAM RD STUDENT HEALTH CENTER -OHARE HALL
BRONX NY
10458-5149
US

IV. Provider business mailing address

441 E. FORDHAM RD. STUDENT HEALTH CENTER -OHARE HALL
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 718-817-4160
  • Fax: 718-817-3218
Mailing address:
  • Phone: 718-817-4160
  • Fax: 718-817-3218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334581-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: