Provider Demographics
NPI:1104073832
Name:FANA, MELISSA D (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:FANA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 HOSPITAL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8811
Mailing Address - Country:US
Mailing Address - Phone:631-228-5899
Mailing Address - Fax:929-455-9828
Practice Address - Street 1:100 HOSPITAL RD STE 106
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8811
Practice Address - Country:US
Practice Address - Phone:631-228-5899
Practice Address - Fax:929-455-9828
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2023-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY264148208600000X
MI4301103263208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery