Provider Demographics
NPI:1396019428
Name:CORNELL, MELISSA N (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:CORNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:N
Other - Last Name:SHIFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:141 SULLYS TRL
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4563
Mailing Address - Country:US
Mailing Address - Phone:585-387-0430
Mailing Address - Fax:585-387-0431
Practice Address - Street 1:141 SULLYS TRL
Practice Address - Street 2:SUITE 9
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4563
Practice Address - Country:US
Practice Address - Phone:585-387-0430
Practice Address - Fax:585-387-0431
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031585-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist