Provider Demographics
NPI:1255983524
Name:BERNADIN, MELISSA HERMELANGE (LPN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:HERMELANGE
Last Name:BERNADIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 COCOANUT ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7223
Mailing Address - Country:US
Mailing Address - Phone:631-636-5548
Mailing Address - Fax:
Practice Address - Street 1:141 COCOANUT ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7223
Practice Address - Country:US
Practice Address - Phone:631-636-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333432164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse