Individual provider Active NPI

Melanie Dwyer-Martin, LPN

  • Licensed Practical Nurse
  • Syracuse, NY
National Provider Identifier
1477059319
Registry record updated Mar 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
129040-1 Issued in NY
Practice address
415 Clover Rd
Syracuse, NY 13219-1423
Phone
(315) 214-4911
NPI assigned
Mar 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 129040-1 NY Primary

Addresses

Primary practice location

415 Clover Rd
Syracuse, NY 13219-1423

Mailing address

415 Clover Rd
Syracuse, NY 13219-1423
Phone (315) 243-6792

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
129040-1NYMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522454400000",
    "number": "1477059319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 CLOVER RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191423",
            "telephone_number": "315-243-6792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 CLOVER RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132191423",
            "telephone_number": "315-214-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWYER-MARTIN",
        "first_name": "MELANIE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-31",
        "last_updated": "2018-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "129040-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.