Healthcare Provider Details

I. General information

NPI: 1124611157
Provider Name (Legal Business Name): MELANIE ANNE CARTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 WALDEN AVE STE 110
DEPEW NY
14043-2400
US

IV. Provider business mailing address

3332 WALDEN AVE STE 110
DEPEW NY
14043-2400
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-7051
  • Fax: 716-288-9501
Mailing address:
  • Phone: 716-668-7051
  • Fax: 716-288-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: