Provider Demographics
NPI:1316475130
Name:SEALE, MELISSA TERESA (PMHNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:TERESA
Last Name:SEALE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK STREET - CREDENTIALING
Mailing Address - Street 2:GLENS FALLS HOSPITAL
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-692-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:1 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3617
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:518-926-7069
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY611091-1163WP0807X
NYF402179363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent