MEDICARE: MELANIE A BRAVO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	136611	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588790018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE A BRAVO

Provider Business Mailing Address
First Line	:	1650 E 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5218
Country	:	US
Telephone Number	:	718-209-1006
Fax Number	:	718-209-0510

Provider Business Practice Location Address
First Line	:	1650 E 91ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5218
Country	:	US
Telephone Number	:	718-209-1006
Fax Number	:	718-209-0510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/21/2015

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Directions to “ MELANIE A BRAVO ” Practice Location

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