Healthcare Provider Details

I. General information

NPI: 1740590702
Provider Name (Legal Business Name): MELISSA ANN JANKOVIC MS, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 STATE ST ROOM 300
ALBANY NY
12207-2005
US

IV. Provider business mailing address

112 STATE ST ROOM 300
ALBANY NY
12207-2005
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-4920
  • Fax: 518-447-4855
Mailing address:
  • Phone: 518-447-4920
  • Fax: 518-447-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: