Provider Demographics
NPI:1992826937
Name:DESA, MELISSA M (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:DESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:BOX PSYCH
Mailing Address - Street 2:601 ELMWOOD AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-279-4900
Mailing Address - Fax:585-461-9504
Practice Address - Street 1:2613 W HENRIETTA RD
Practice Address - Street 2:STRONG TIES
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-279-4900
Practice Address - Fax:585-461-9504
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2598222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program