Provider Demographics
NPI:1316955214
Name:MELNICK, BENEDETTA M (NPP)
Entity type:Individual
Prefix:
First Name:BENEDETTA
Middle Name:M
Last Name:MELNICK
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:MELNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2209 GENESEE ST.
Mailing Address - Street 2:BUSINESS OFFICE-ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1427 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4343
Practice Address - Country:US
Practice Address - Phone:315-798-8868
Practice Address - Fax:315-738-1461
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400170-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA2569Medicare ID - Type Unspecified