Provider Demographics
NPI:1083159073
Name:SAN LUIS, MELANIE SEMILLA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:SEMILLA
Last Name:SAN LUIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:BELTRAN
Other - Last Name:SEMILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:321 MOSEL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3416
Mailing Address - Country:US
Mailing Address - Phone:917-436-7054
Mailing Address - Fax:
Practice Address - Street 1:321 MOSEL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3416
Practice Address - Country:US
Practice Address - Phone:917-436-7054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse