Healthcare Provider Details

I. General information

NPI: 1700580206
Provider Name (Legal Business Name): MELISSA FISCHETTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA DEGUGLIELMO

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 SUMMERFIELD ST
SCARSDALE NY
10583-5479
US

IV. Provider business mailing address

154 W 70TH ST APT 6G
NEW YORK NY
10023-4404
US

V. Phone/Fax

Practice location:
  • Phone: 914-472-2929
  • Fax:
Mailing address:
  • Phone: 212-305-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number065758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: