Healthcare Provider Details

I. General information

NPI: 1417775305
Provider Name (Legal Business Name): MELISSA ZACHOLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 225
MARIETTA NY
13110-0225
US

IV. Provider business mailing address

PO BOX 225
MARIETTA NY
13110-0225
US

V. Phone/Fax

Practice location:
  • Phone: 315-488-7261
  • Fax:
Mailing address:
  • Phone: 315-488-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number506797-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: