Provider Demographics
NPI:1194397141
Name:MELENDEZ-RIVAS, EILEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:
Last Name:MELENDEZ-RIVAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7407
Mailing Address - Country:US
Mailing Address - Phone:631-388-7500
Mailing Address - Fax:
Practice Address - Street 1:737 COMMACK RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7407
Practice Address - Country:US
Practice Address - Phone:631-388-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-10
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily