MEDICARE: MRS. BETTY ANN SUSAN MELVILLE-DYCE NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	F336539	NY

General Provider Information

NPI Number	:	1568724987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETTY ANN SUSAN MELVILLE-DYCE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	150 E 42ND ST
Second Line	:	FL 10
City	:	NEW YORK
State	:	NY
Zip	:	10017-5612
Country	:	US
Telephone Number	:	646-605-8119
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 STERLING ST
Second Line	:	APT 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3433
Country	:	US
Telephone Number	:	718-940-4541
Fax Number	:

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

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	02/27/2020

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