Provider Demographics
NPI:1861739872
Name:FLYNN, MELISSA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:FLYNN
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 1:4271 HEMPSTEAD TPKE STE 1
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5708
Mailing Address - Country:US
Mailing Address - Phone:516-796-3700
Mailing Address - Fax:
Practice Address - Street 1:4271 HEMPSTEAD TPKE STE 1
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5708
Practice Address - Country:US
Practice Address - Phone:516-796-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337348-1363LF0000X
NY557251-1163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03938332Medicaid