Provider Demographics
NPI:1144678889
Name:CARDINAL, MELISSA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776A 6TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6304
Mailing Address - Country:US
Mailing Address - Phone:917-201-7307
Mailing Address - Fax:917-810-4483
Practice Address - Street 1:776A 6TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6304
Practice Address - Country:US
Practice Address - Phone:917-201-7307
Practice Address - Fax:917-810-4483
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402084-1363LP0808X
NJ26NJ00655200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health