Healthcare Provider Details

I. General information

NPI: 1205378221
Provider Name (Legal Business Name): MELLISA ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLAZA ST E STE 1E
BROOKLYN NY
11238-4952
US

IV. Provider business mailing address

10 CALLAWAY DR
MONROE NY
10950-3055
US

V. Phone/Fax

Practice location:
  • Phone: 347-564-3211
  • Fax: 347-710-1959
Mailing address:
  • Phone: 347-423-8542
  • Fax: 347-710-1959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number341016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: