Provider Demographics
NPI:1356537922
Name:COLE, MELISSA DIANE (RPA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:COLE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DIANE
Other - Last Name:LEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:EOU
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7000
Mailing Address - Fax:
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:EOU
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12208363AM0700X
NY012208363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00742876-DD1972OtherRAILROAD MEDICARE
NY03024357Medicaid
NYPA2186- GRP: BA0017Medicare PIN
NYP00742876-DD1972OtherRAILROAD MEDICARE