Individual
MELINDA CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RN, FNP, PMHNP
Contact information
Practice address
80 ORVILLE DR STE 100, BOHEMIA, NY 11716-2505
(631) 500-5925
(631) 500-5979
Mailing address
80 ORVILLE DR STE 100, BOHEMIA, NY 11716-2505
(631) 500-5925
(631) 500-5979
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
687063
NY
363L00000X
Nurse Practitioner
Primary
344753
NY
363LF0000X
Family Nurse Practitioner
344753
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
405889
NY
Other
Enumeration date
03/20/2012
Last updated
10/18/2024
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