Provider Demographics
NPI:1487091617
Name:PLOUTZ, MELISANDE JOY (PNP)
Entity type:Individual
Prefix:
First Name:MELISANDE
Middle Name:JOY
Last Name:PLOUTZ
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 661
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8410
Mailing Address - Country:US
Mailing Address - Phone:585-275-1000
Mailing Address - Fax:585-276-1985
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 661
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-8410
Practice Address - Country:US
Practice Address - Phone:585-275-1000
Practice Address - Fax:585-276-1985
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382382363LP0200X
NY382382363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03596870Medicaid
NY03596870Medicaid