Healthcare Provider Details

I. General information

NPI: 1437115300
Provider Name (Legal Business Name): MELISSA N SCIOLINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PROFESSIONAL PARKWAY
LOCKPORT NY
14094
US

IV. Provider business mailing address

139 PROFESSIONAL PARKWAY
LOCKPORT NY
14094
US

V. Phone/Fax

Practice location:
  • Phone: 716-433-6711
  • Fax: 716-433-0546
Mailing address:
  • Phone: 716-433-6711
  • Fax: 716-433-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number220973
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220973
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1211256
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH
# 2
Identifier02161791
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier000526470001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS BLUE SHIELD
# 4
Identifier00025704701
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNIVERA HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: