Provider Demographics
NPI:1376831594
Name:DESOUZA, MELISSA JANE (RPA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JANE
Other - Last Name:PUCHALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:199 PARK CLUB LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5269
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-836-4696
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-929-2800
Practice Address - Fax:716-929-2819
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014927363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical