Healthcare Provider Details

I. General information

NPI: 1841781010
Provider Name (Legal Business Name): MELISSA CAROLINA RIESS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CENTRAL AVE
FAR ROCKAWAY NY
11691-4002
US

IV. Provider business mailing address

170 OLD COUNTRY RD
RIVERHEAD NY
11901-2198
US

V. Phone/Fax

Practice location:
  • Phone: 718-223-5820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: