Healthcare Provider Details

I. General information

NPI: 1962737130
Provider Name (Legal Business Name): MELINA MEJIA RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 171ST ST APT A
NEW YORK NY
10032-2818
US

IV. Provider business mailing address

707 W 171ST ST APT A
NEW YORK NY
10032-2818
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-3232
  • Fax: 212-927-4573
Mailing address:
  • Phone: 212-927-3232
  • Fax: 212-927-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: