Provider Demographics
NPI:1740249937
Name:MELONI, STEPHEN JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:MELONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W JEFFERSON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1090
Mailing Address - Country:US
Mailing Address - Phone:585-602-0500
Mailing Address - Fax:
Practice Address - Street 1:2300 W JEFFERSON RD STE 400
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1090
Practice Address - Country:US
Practice Address - Phone:585-602-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195-094207R00000X
NY195094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016774033Medicaid
NYMDF361OtherPREFERRED CARE
NYP010195094OtherBLUE CHOICE
NYP020195094OtherBLUE SHIELD ROCHESTER
NYCC0942Medicare ID - Type Unspecified
NYP020195094OtherBLUE SHIELD ROCHESTER