Provider Demographics
NPI:1861706913
Name:TELLIER, MELINDA (FNP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:TELLIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0601
Mailing Address - Country:US
Mailing Address - Phone:585-335-3416
Mailing Address - Fax:
Practice Address - Street 1:50 E SOUTH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1300
Practice Address - Country:US
Practice Address - Phone:585-243-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-31
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574057-1163W00000X
NYF336289-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP01035970OtherMEDICARE RR
NYJ400027925Medicare PIN
J400027926Medicare PIN