Provider Demographics
NPI:1528084688
Name:TAYLOR-BOBB, MELISSA (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TAYLOR-BOBB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E. FORDHAM RD.
Mailing Address - Street 2:STUDENT HEALTH CENTER -OHARE HALL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-817-4160
Mailing Address - Fax:718-817-3218
Practice Address - Street 1:441 E FORDHAM RD
Practice Address - Street 2:STUDENT HEALTH CENTER -OHARE HALL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5149
Practice Address - Country:US
Practice Address - Phone:718-817-4160
Practice Address - Fax:718-817-3218
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334581-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02759066Medicaid