Provider Demographics
NPI:1679717102
Name:TORRES, MELISSIA AMANDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSIA
Middle Name:AMANDA
Last Name:TORRES
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 1:61 W HAM CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-9763
Mailing Address - Country:US
Mailing Address - Phone:585-571-4186
Mailing Address - Fax:
Practice Address - Street 1:61 W HAM CIR
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-9763
Practice Address - Country:US
Practice Address - Phone:585-571-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457181-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02888815Medicaid