# MELISSA STOCKMAN ADULT CARE NP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952780736
- **Authorized official:** MELISSA SONYA STOCKMAN MS, RN CS, ANP, PNP (OWNER)
- **Authorized official phone:** (631) 758-5635

## Contact information

- **Practice address:** 41 GREENPORT AVE, MEDFORD, NY 11763-3601
- **Practice address phone:** (631) 758-5635
- **Mailing address:** 41 GREENPORT AVE, MEDFORD, NY 11763-3601
- **Mailing address phone:** (631) 758-5635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | F302133-1 | NY | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | F381245-1 | NY | — |

## Other

- **Enumeration date:** 05/26/2015
- **Last updated:** 05/26/2015