Provider Demographics
NPI:1467615591
Name:SHAH, MELANIE (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SOKOLOVSKIY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:621 TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14302
Mailing Address - Country:US
Mailing Address - Phone:716-278-4000
Mailing Address - Fax:716-362-9518
Practice Address - Street 1:621 TENTH STREET
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14302
Practice Address - Country:US
Practice Address - Phone:716-278-4000
Practice Address - Fax:716-362-9518
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03030480Medicaid