Individual
MRS. MELISSA SUE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
133 MARGARET ST, PLATTSBURGH, NY 12901-2926
(518) 565-4868
(518) 565-4509
Mailing address
133 MARGARET ST, PLATTSBURGH, NY 12901-2926
(518) 565-4868
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
1740207299
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00583757
—
NY
Enumeration date
08/10/2017
Last updated
06/11/2019
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