Provider Demographics
NPI:1619124823
Name:GRAGEDA, MELISSA RENEE RICAFRENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA RENEE
Middle Name:RICAFRENTE
Last Name:GRAGEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 43RD AVE APT 3J
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1840
Mailing Address - Country:US
Mailing Address - Phone:917-349-7004
Mailing Address - Fax:
Practice Address - Street 1:7402 43RD AVE APT 3J
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1840
Practice Address - Country:US
Practice Address - Phone:917-349-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13902208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics