Provider Demographics
NPI:1598420895
Name:FAHEY, MELISSA J (RN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:FAHEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MACDOUGALL ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4824
Mailing Address - Country:US
Mailing Address - Phone:315-289-8754
Mailing Address - Fax:
Practice Address - Street 1:34 MACDOUGALL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4824
Practice Address - Country:US
Practice Address - Phone:315-289-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706733163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health