Provider Demographics
NPI:1023083292
Name:D'AMATO, MELISSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:D'AMATO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CORNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:140 HAZARD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5424
Mailing Address - Country:US
Mailing Address - Phone:860-714-9733
Mailing Address - Fax:
Practice Address - Street 1:140 HAZARD AVE STE 105
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5424
Practice Address - Country:US
Practice Address - Phone:860-714-9733
Practice Address - Fax:860-714-8136
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010711-1363A00000X
CT004904363A00000X
FLPA9104557363AM0700X
CT4904363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000728800Medicaid
FL685778036AMedicaid
GARAILROAD MEDICAREOtherP00727972
GARAILROAD MEDICAREOtherP00727972
FL685778036AMedicaid