Provider Demographics
NPI:1003885385
Name:SPENCER-WINKER, MELISSA ANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:SPENCER-WINKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3041 ORCHARD PARK RD STE C
Mailing Address - Street 2:ATT: CREDENTIALING
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1238
Mailing Address - Country:US
Mailing Address - Phone:716-674-3104
Mailing Address - Fax:716-674-0666
Practice Address - Street 1:6420 TRANSIT RD STE A
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1033
Practice Address - Country:US
Practice Address - Phone:716-845-1600
Practice Address - Fax:716-242-0201
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0080761207N00000X, 363A00000X
NY017771207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02564450Medicaid
NYQ04409Medicare UPIN