Provider Demographics
NPI:1477918019
Name:KONIKOFF-SCHUVAL, MELISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KONIKOFF-SCHUVAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OHIO DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE SUCCES
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1129
Mailing Address - Country:US
Mailing Address - Phone:516-328-8700
Mailing Address - Fax:516-224-1540
Practice Address - Street 1:6 OHIO DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1129
Practice Address - Country:US
Practice Address - Phone:516-328-8700
Practice Address - Fax:516-224-1540
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3706363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical