Healthcare Provider Details

I. General information

NPI: 1740340306
Provider Name (Legal Business Name): FRANCINE SHEILA MELODIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CLINTON STREET
BROOKLYN NY
11201
US

IV. Provider business mailing address

9201 SHORE ROAD A701
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-852-7575
  • Fax: 718-852-1130
Mailing address:
  • Phone: 718-852-7575
  • Fax: 718-852-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number116189
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: