Provider Demographics
NPI:1770246878
Name:HADDAD, MELANIE A (FNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:HADDAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6307
Mailing Address - Country:US
Mailing Address - Phone:315-798-8737
Mailing Address - Fax:
Practice Address - Street 1:110 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6307
Practice Address - Country:US
Practice Address - Phone:315-798-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22225400163W00000X
NY754089163W00000X
NY3523282081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No163W00000XNursing Service ProvidersRegistered Nurse