Healthcare Provider Details

I. General information

NPI: 1225301922
Provider Name (Legal Business Name): EILEEN MELINIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LONG WOOD DR
ROCHESTER NY
14612-2713
US

IV. Provider business mailing address

399 OGDEN PARMA TOWN LINE RD
SPENCERPORT NY
14559-1654
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-7509
  • Fax:
Mailing address:
  • Phone: 585-349-5651
  • Fax: 585-349-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number365540-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number365540-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: