Healthcare Provider Details

I. General information

NPI: 1225271166
Provider Name (Legal Business Name): MELIORA FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 HUDSON AVE
STILLWATER NY
12170
US

IV. Provider business mailing address

172 HUDSON AVE PO BOX 173
STILLWATER NY
12170
US

V. Phone/Fax

Practice location:
  • Phone: 877-664-6116
  • Fax: 877-664-6116
Mailing address:
  • Phone: 877-664-6116
  • Fax: 877-664-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA247491
License Number StateNY

VIII. Authorized Official

Name: DR. JESSICA DAVIS
Title or Position: SOLO PHYSICIAN, OWNER
Credential: M.D.
Phone: 877-664-6116