Provider Demographics
NPI:1184999344
Name:CLARKE, MELINDA (MS, RN, FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MS, RN, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ORVILLE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-2505
Mailing Address - Country:US
Mailing Address - Phone:631-500-5925
Mailing Address - Fax:631-500-5979
Practice Address - Street 1:80 ORVILLE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2505
Practice Address - Country:US
Practice Address - Phone:631-500-5925
Practice Address - Fax:631-500-5979
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY687063163W00000X, 163WX0800X
NY344753363LF0000X, 363L00000X, 363LF0000X
NY405889363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic