Provider Demographics
NPI:1043276603
Name:AZAULA, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:AZAULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0034
Mailing Address - Fax:716-323-0292
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0034
Practice Address - Fax:716-323-0292
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1948292080P0006X, 2081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01654044Medicaid
040426000781OtherDIDELIS
PA0018526310001Medicaid
3008167OtherIHA
000524267006OtherBC/BS
3008167OtherIHA
NY01654044Medicaid
PA0018526310001Medicaid