Healthcare Provider Details

I. General information

NPI: 1619440989
Provider Name (Legal Business Name): MELISSA VIGNONA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 59TH ST
BROOKLYN NY
11220-3936
US

IV. Provider business mailing address

26 FIREMENS MEMORIAL DR STE 115
POMONA NY
10970-3569
US

V. Phone/Fax

Practice location:
  • Phone: 800-750-8616
  • Fax:
Mailing address:
  • Phone: 845-362-8400
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0424439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: