Individual
MRS. MELBA PAULOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
194-44 WOODHULL AVE, HOLLIS, QUEENS, NY 11423
(516) 967-3681
Mailing address
17 5TH PL, SYOSSET, NY 11791-3605
(516) 967-3681
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
F310011-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F310011-01
—
NY
Enumeration date
12/13/2021
Last updated
12/13/2021
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