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General NPI Number Information
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NPI Number | 1477918019
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Entity Type | Individual
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Provider Name | MELISSA KONIKOFF-SCHUVAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 6 OHIO DRIVE SUITE 201
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1129
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Country | US
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Telephone | 516-328-8700
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Fax | 516-224-1540
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Provider Business Mailing Address
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Address Line | 6 OHIO DRIVE SUITE 201
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City | LAKE SUCCES
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State | NY
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Zip | 11042-1129
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Country | US
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Telephone | 516-328-8700
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Fax | 516-224-1540
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3706
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License Number State | NY
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