Healthcare Provider Details

I. General information

NPI: 1477251429
Provider Name (Legal Business Name): AMY NAOMY MELENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 RIDGE RD
SODUS NY
14551-9743
US

IV. Provider business mailing address

601B W WASHINGTON ST
GENEVA NY
14456-2119
US

V. Phone/Fax

Practice location:
  • Phone: 315-483-1199
  • Fax:
Mailing address:
  • Phone: 315-781-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033305
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: