Healthcare Provider Details

I. General information

NPI: 1801049929
Provider Name (Legal Business Name): MELISSA KYLE KUERSTEINER M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6575 KIRKVILLE RD STE 1
EAST SYRACUSE NY
13057-9809
US

IV. Provider business mailing address

105 HAZELHURST AVE
NORTH SYRACUSE NY
13212-2715
US

V. Phone/Fax

Practice location:
  • Phone: 315-701-5710
  • Fax: 315-701-5711
Mailing address:
  • Phone: 315-458-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number007377-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: