Provider Demographics
NPI:1639106867
Name:LOPARCO, MELONY SUE (RPAC)
Entity Type:Individual
Prefix:MS
First Name:MELONY
Middle Name:SUE
Last Name:LOPARCO
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:MRS
Other - First Name:MELONY
Other - Middle Name:SUE
Other - Last Name:SANDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPAC
Mailing Address - Street 1:134 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1206
Mailing Address - Country:US
Mailing Address - Phone:607-749-5708
Mailing Address - Fax:
Practice Address - Street 1:1104 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1643
Practice Address - Country:US
Practice Address - Phone:607-758-3750
Practice Address - Fax:607-758-3754
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006919-1363AM0700X, 363AS0400X
NY1039516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02229050Medicaid
NYDD5313Medicare ID - Type Unspecified
NY02229050Medicaid