Provider Demographics
NPI:1154073955
Name:MOREIRA, MELISSA NOACH (AGNP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NOACH
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CLAPBOARD RIDGE RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4559
Mailing Address - Country:US
Mailing Address - Phone:845-282-2540
Mailing Address - Fax:
Practice Address - Street 1:12 CLAPBOARD RIDGE RD UNIT 9
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4559
Practice Address - Country:US
Practice Address - Phone:845-282-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10597363LA2200X
NY310738363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health