Provider Demographics
NPI:1144922683
Name:POLIDORI, MELISSA NOEL (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:NOEL
Last Name:POLIDORI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:NOEL
Other - Last Name:MOFFATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-0406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13406-1820
Practice Address - Country:US
Practice Address - Phone:315-982-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse