Healthcare Provider Details

I. General information

NPI: 1811461288
Provider Name (Legal Business Name): MELISSA JOSE CHARLES RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BERRY ST
BROOKLYN NY
11249-4106
US

IV. Provider business mailing address

250 BERRY ST
BROOKLYN NY
11249-4106
US

V. Phone/Fax

Practice location:
  • Phone: 718-387-8935
  • Fax: 718-387-8935
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number678633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: