Provider Demographics
NPI:1588793400
Name:MALONE, MELISSA K (PNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:MALONE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2618
Mailing Address - Country:US
Mailing Address - Phone:203-622-6556
Mailing Address - Fax:203-517-1058
Practice Address - Street 1:1 SALEM ST
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2618
Practice Address - Country:US
Practice Address - Phone:203-622-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381480363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics