Provider Demographics
NPI:1215117916
Name:DHUNDALE, MELISSA (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DHUNDALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601B W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2119
Mailing Address - Country:US
Mailing Address - Phone:315-781-8448
Mailing Address - Fax:315-781-8444
Practice Address - Street 1:601B W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2119
Practice Address - Country:US
Practice Address - Phone:315-781-8448
Practice Address - Fax:315-781-8444
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02952541Medicaid
NY241123OtherLICENSE