Provider Demographics
NPI:1326705062
Name:CANTOR, MELISSA (CM)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:CANTOR
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAPLE LEAF RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3030
Mailing Address - Country:US
Mailing Address - Phone:845-425-3176
Mailing Address - Fax:
Practice Address - Street 1:40 ROBERT PITT DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3333
Practice Address - Country:US
Practice Address - Phone:845-352-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002118367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife