Provider Demographics
NPI:1437010899
Name:MELISSA PENNANT
Entity type:Organization
Organization Name:MELISSA PENNANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:718-809-9685
Mailing Address - Street 1:189 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4903
Mailing Address - Country:US
Mailing Address - Phone:718-809-9685
Mailing Address - Fax:718-228-7059
Practice Address - Street 1:189 BEECH ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4903
Practice Address - Country:US
Practice Address - Phone:718-809-9685
Practice Address - Fax:718-228-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty