Healthcare Provider Details

I. General information

NPI: 1619124823
Provider Name (Legal Business Name): MELISSA RENEE RICAFRENTE GRAGEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1699
US

IV. Provider business mailing address

7402 43RD AVE APT 3J
ELMHURST NY
11373-1840
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-4636
  • Fax:
Mailing address:
  • Phone: 917-349-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13902
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA09240800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number250802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: