Provider Demographics
NPI:1255484226
Name:SUTHERLAND, MELISSA ANN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 VESTAL AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1500
Mailing Address - Country:US
Mailing Address - Phone:607-760-8039
Mailing Address - Fax:
Practice Address - Street 1:225 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2424
Practice Address - Country:US
Practice Address - Phone:607-778-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494239-1163W00000X
NYF320034-1363LC1500X
VA0024166427363LF0000X
VA163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily