Healthcare Provider Details

I. General information

NPI: 1811500028
Provider Name (Legal Business Name): MS. MELLISA DEANDRADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BOWMAN AVE
RYE BROOK NY
10573-2808
US

IV. Provider business mailing address

179 DRAKE AVE APT 2K
NEW ROCHELLE NY
10805-1747
US

V. Phone/Fax

Practice location:
  • Phone: 914-939-1477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202631228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: