Healthcare Provider Details

I. General information

NPI: 1427303353
Provider Name (Legal Business Name): MELISSA J BENARDOT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CTY RT 57 COMMUNITY HEALTH CENTER
MALONE NY
12953
US

IV. Provider business mailing address

4 COMMERCE LANE COMMUNITY HEALTH CENTER
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-0109
  • Fax: 518-483-0115
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382304
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344053
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: