MEDICARE: MELISSA ANN DAVIDSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	302654	NY
2	163W00000X	Registered Nurse	698875	NY

General Provider Information

NPI Number	:	1508165523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN DAVIDSON RN

Provider Business Mailing Address
First Line	:	86 GRANITE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1618
Country	:	US
Telephone Number	:	718-574-5964
Fax Number	:

Provider Business Practice Location Address
First Line	:	86 GRANITE ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11207-1618
Country	:	US
Telephone Number	:	718-574-5964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	08/13/2015

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