Provider Demographics
NPI:1346489119
Name:GALLISON, MELISSA (PHD, ANP, MPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GALLISON
Suffix:
Gender:F
Credentials:PHD, ANP, MPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GALLISON
Other - Last Name:BLACKSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, ANP, MPH
Mailing Address - Street 1:300 MERIDIAN CENTRE BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3981
Mailing Address - Country:US
Mailing Address - Phone:585-463-3100
Mailing Address - Fax:585-463-3105
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:STE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:585-463-3100
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300795363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health