Provider Demographics
NPI:1316483894
Name:CARBONETTE, MELISSA LEIGH (PNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEIGH
Last Name:CARBONETTE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEIGH
Other - Last Name:CARDONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 1ST ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 1ST ST
Practice Address - Street 2:#205
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4084
Practice Address - Country:US
Practice Address - Phone:516-741-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646067-1163WN0003X
NYF382691-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk