Healthcare Provider Details

I. General information

NPI: 1598549982
Provider Name (Legal Business Name): MELISSA HURTADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-1000
US

IV. Provider business mailing address

1000 N VILLAGE AVE
ROCKVILLE CENTRE NY
11570-1000
US

V. Phone/Fax

Practice location:
  • Phone: 631-465-6338
  • Fax:
Mailing address:
  • Phone: 631-465-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030413-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: