Healthcare Provider Details

I. General information

NPI: 1740134436
Provider Name (Legal Business Name): MELISSA PANAMENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERRICK RD STE 128W
ROCKVILLE CENTRE NY
11570-4821
US

IV. Provider business mailing address

100 MERRICK RD STE 128W
ROCKVILLE CENTRE NY
11570-4821
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-9031
  • Fax:
Mailing address:
  • Phone: 516-255-9031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: