MEDICARE: TIMOTHY STEVEN MELNYK M.A.

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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1942606520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY STEVEN MELNYK M.A.

Provider Business Mailing Address
First Line	:	1550 LIVINGSTON DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2420
Country	:	US
Telephone Number	:	702-601-4087
Fax Number	:

Provider Business Practice Location Address
First Line	:	6877 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	702-446-8034
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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