Healthcare Provider Details

I. General information

NPI: 1114178845
Provider Name (Legal Business Name): MELISSA AUSILIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 VOLUNTEER LN
SACRAMENTO CA
95826-3221
US

IV. Provider business mailing address

PO BOX 162478
SACRAMENTO CA
95816-2478
US

V. Phone/Fax

Practice location:
  • Phone: 916-215-7940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: