Basic Information
| Provider Information | |||||||||
| NPI: | 1750415766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DERBOGHOSSIAN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MERIDIAN CENTRE BLVD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184691064 | ||||||||
| FaxNumber: | 5854633105 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MERIDIAN CENTRE BLVD | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184691064 | ||||||||
| FaxNumber: | 5854633105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F33041-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 334140 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.