Provider Demographics
NPI:1083752034
Name:O'SULLIVAN, MELISSA J (N P)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 WINTON RD S
Mailing Address - Street 2:BLDG 4 SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3916
Mailing Address - Country:US
Mailing Address - Phone:585-473-0495
Mailing Address - Fax:585-442-0750
Practice Address - Street 1:1870 WINTON RD S
Practice Address - Street 2:BLDG 4 SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3916
Practice Address - Country:US
Practice Address - Phone:585-473-0495
Practice Address - Fax:585-442-0750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300749363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health