Healthcare Provider Details

I. General information

NPI: 1538072715
Provider Name (Legal Business Name): MELISSA PAMELA SURIEL ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 GUY LOMBARDO AVE
FREEPORT NY
11520-6246
US

IV. Provider business mailing address

541 GUY LOMBARDO AVE
FREEPORT NY
11520-6246
US

V. Phone/Fax

Practice location:
  • Phone: 516-359-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: