Healthcare Provider Details

I. General information

NPI: 1063297232
Provider Name (Legal Business Name): MELINDA DAVIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONIFER PARK 556 CLINTON AVENUE SOUTH
ROCHESTER NY
14620
US

IV. Provider business mailing address

CONIFER PARK 556 CLINTON AVENUE SOUTH
ROCHESTER NY
14620-3741
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-8422
  • Fax: 585-442-8494
Mailing address:
  • Phone: 585-442-8422
  • Fax: 585-442-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number580728-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: