Provider Demographics
NPI:1346593985
Name:WILLIAMS, MELISSA A (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2502
Mailing Address - Country:US
Mailing Address - Phone:631-960-2459
Mailing Address - Fax:631-730-3099
Practice Address - Street 1:47 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2502
Practice Address - Country:US
Practice Address - Phone:631-960-2459
Practice Address - Fax:631-730-3099
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse