Healthcare Provider Details

I. General information

NPI: 1942550017
Provider Name (Legal Business Name): MELINDA SUE HAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LONG AVE SUITE NUMBER 110
HAMBURG NY
14075-6200
US

IV. Provider business mailing address

17 LONG AVE SUITE NUMBER 110
HAMBURG NY
14075-6200
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-5188
  • Fax:
Mailing address:
  • Phone: 716-646-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number22616263
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number340457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: