Provider Demographics
NPI:1770774556
Name:SMITH, MELANIE ANNE (PNP)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:GAMBASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 WATERSIDE PLZ
Mailing Address - Street 2:APT 7B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2622
Mailing Address - Country:US
Mailing Address - Phone:631-428-1538
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-2060
Practice Address - Fax:718-653-1587
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381882-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics