Provider Demographics
NPI:1558839902
Name:VASEY, MELISSA KATHLEEN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATHLEEN
Last Name:VASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 MIDLAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-3359
Mailing Address - Country:US
Mailing Address - Phone:845-649-9448
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD STE 307
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2530
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:845-624-0264
Is Sole Proprietor?:No
Enumeration Date:2018-11-04
Last Update Date:2018-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse