Provider Demographics
NPI:1629392121
Name:VAN SISE, MELANIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:VAN SISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:45 RESEARCH WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-675-2125
Mailing Address - Fax:631-675-2624
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-751-9595
Practice Address - Fax:631-751-2322
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY274136207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine