Milissa Pendergast

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

281573-01 Issued in NY

Practice address

75 New Scotland Ave Unit D
Albany, NY 12208-3474

Phone

(518) 549-6894

NPI assigned

Oct 17, 2024

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1700607306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 NEW SCOTLAND AVE UNIT D",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083474",
            "telephone_number": "518-549-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 NEW SCOTLAND AVE UNIT D",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122083474",
            "telephone_number": "518-549-6894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGAST",
        "first_name": "MILISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "281573-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Peltier
• Bridget Pelton
• Ashley Ann Penalberth Arroyo
• Stanley F Penc, MD PHD
• Jessemyn Pence, PT
• Justin Potter Pendergrast, PA-C
• Tiana Rose Pendleton, SLP
• Tara Nagle Penesso, LCSW R
• Christine Marie Penicka, MS, RD, PA-C
• Hugh Penk

• Licensed Practical Nurse in Albany, NY
• Providers in Albany, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.