Provider Demographics
NPI:1649816125
Name:SIMMONS, MELINDA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WADSWORTH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3862
Mailing Address - Country:US
Mailing Address - Phone:646-329-6100
Mailing Address - Fax:646-329-6310
Practice Address - Street 1:201 WADSWORTH AVE STE 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3862
Practice Address - Country:US
Practice Address - Phone:646-329-6100
Practice Address - Fax:646-329-6310
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2019052381363LF0000X
NY345268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily