Healthcare Provider Details

I. General information

NPI: 1376617605
Provider Name (Legal Business Name): MELISSA RUBADEAUX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 WILLIAM ST
BUFFALO NY
14206-1649
US

IV. Provider business mailing address

608 WILLIAM ST
BUFFALO NY
14206-1649
US

V. Phone/Fax

Practice location:
  • Phone: 716-858-7049
  • Fax: 716-585-2127
Mailing address:
  • Phone: 716-858-7049
  • Fax: 716-585-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF42074301
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: