Healthcare Provider Details

I. General information

NPI: 1720379803
Provider Name (Legal Business Name): MELANIE ECUNG DEYSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD
ALBANY NY
12208-1707
US

IV. Provider business mailing address

77 NEALY AVE 633RD MDG/SGHM
HAMPTON VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1550
  • Fax:
Mailing address:
  • Phone: 757-764-1308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number296708
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number296708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: