Provider Demographics
NPI:1124625967
Name:HEBERT, MA. MELITA MENDOZA (NP)
Entity type:Individual
Prefix:MRS
First Name:MA. MELITA
Middle Name:MENDOZA
Last Name:HEBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 FIESTA RD
Mailing Address - Street 2:
Mailing Address - City:GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3841
Mailing Address - Country:US
Mailing Address - Phone:585-615-4100
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0002
Practice Address - Country:US
Practice Address - Phone:585-275-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309656363L00000X
NYF309656-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner