Healthcare Provider Details

I. General information

NPI: 1255498192
Provider Name (Legal Business Name): SOFIA B MELENEVSKAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 ALLSTON ST SUITE B
BRIGHTON MA
02135
US

IV. Provider business mailing address

PO BOX 59037
NEWTON MA
02459
US

V. Phone/Fax

Practice location:
  • Phone: 617-734-1300
  • Fax: 617-734-1330
Mailing address:
  • Phone: 853-301-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number48371
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: