Healthcare Provider Details

I. General information

NPI: 1730170606
Provider Name (Legal Business Name): MELINDA A.S PISARO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CULVER RD
ROCHESTER NY
14609
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 668
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-7892
  • Fax: 585-442-1666
Mailing address:
  • Phone: 585-275-7892
  • Fax: 585-482-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number1076
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: