Melissa Dale Liz, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F348276-01 Issued in NY

Practice address

540 Union Blvd
West Islip, NY 11795-3105

Phone

(631) 669-2555

NPI assigned

Mar 22, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Melissa Dale McKenna Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Francis Hospital United States Catholic Conference

  dba St Francis Ekg

  • General Acute Care Hospital
  • Roslyn, NY
  • NPI 1750439030
  NPD (past)

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1689323164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 MUNCEY RD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117065335",
            "telephone_number": "631-691-9129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 UNION BLVD",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117953105",
            "telephone_number": "631-669-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIZ",
        "first_name": "MELISSA",
        "middle_name": "DALE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-22",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F348276-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "MCKENNA",
            "middle_name": "DALE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Michaela Lynn Lomelo
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• Family Nurse Practitioner in West Islip, NY
• Providers in West Islip, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; 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.