Individual
LISHA MELATHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
100 WOODS RD, VALHALLA, NY 10595-1530
(914) 493-2363
(914) 493-2505
Mailing address
19 BRADHURST AVE, SUITE 3100N, HAWTHORNE, NY 10532-2140
(914) 909-9018
(914) 909-9028
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
009519
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009519
NYS LICENSE
NY
Enumeration date
08/29/2006
Last updated
09/13/2016
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