Healthcare Provider Details

I. General information

NPI: 1326958182
Provider Name (Legal Business Name): MELISSA O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 RIDGE RD
LANSING NY
14882-8930
US

IV. Provider business mailing address

79 AUTUMN RIDGE CIR
ITHACA NY
14850-8533
US

V. Phone/Fax

Practice location:
  • Phone: 607-533-3020
  • Fax: 607-533-4829
Mailing address:
  • Phone: 607-592-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number575652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: