Provider Demographics
NPI:1376617605
Name:RUBADEAUX, MELISSA (NP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:RUBADEAUX
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 1:608 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206-1649
Mailing Address - Country:US
Mailing Address - Phone:716-858-7049
Mailing Address - Fax:716-585-2127
Practice Address - Street 1:608 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-1649
Practice Address - Country:US
Practice Address - Phone:716-858-7049
Practice Address - Fax:716-585-2127
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF42074301363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
500560925001OtherBCBS
9512834OtherIHA
160746860OtherUNIVERA