Provider Demographics
NPI:1073602686
Name:MANUS, MELISSA A (PA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MANUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1447
Mailing Address - Country:US
Mailing Address - Phone:518-453-9088
Mailing Address - Fax:518-689-3896
Practice Address - Street 1:530 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2014
Practice Address - Country:US
Practice Address - Phone:518-382-7200
Practice Address - Fax:518-382-7205
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P82498Medicare UPIN
PA1050Medicare ID - Type Unspecified
PA1051Medicare ID - Type UnspecifiedCLIFTON PARK