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General NPI Number Information
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NPI Number | 1013426261
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Entity Type | Individual
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Provider Name | MELISSA REILLY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 09/20/2017
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Provider Practice Location Address
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Address Line | 329 E MAIN ST STE 9
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City | SMITHTOWN
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State | NY
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Zip | 11787-2831
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Country | US
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Telephone | 631-366-2333
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Fax |
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Provider Business Mailing Address
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Address Line | 16 HARLOQUIN DR
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City | SMITHTOWN
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State | NY
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Zip | 11787-3310
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Country | US
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Telephone | 646-773-6281
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F339838
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License Number State | NY
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