Healthcare Provider Details

I. General information

NPI: 1003463803
Provider Name (Legal Business Name): ALYSSA DANIELLE MELVIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

IV. Provider business mailing address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-8909
  • Fax: 845-791-4136
Mailing address:
  • Phone: 845-333-7575
  • Fax: 845-333-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: