Healthcare Provider Details

I. General information

NPI: 1124625967
Provider Name (Legal Business Name): MA. MELITA MENDOZA HEBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 07/03/2023
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0002
US

IV. Provider business mailing address

253 FIESTA RD
GREECE NY
14626-3841
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2901
  • Fax:
Mailing address:
  • Phone: 585-615-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number309656
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF309656-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: