Healthcare Provider Details

I. General information

NPI: 1619653581
Provider Name (Legal Business Name): KRISTAN MELO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN CITY PLZ STE 312
GARDEN CITY NY
11530-3331
US

IV. Provider business mailing address

300 GARDEN CITY PLZ STE 312
GARDEN CITY NY
11530-3331
US

V. Phone/Fax

Practice location:
  • Phone: 516-216-9491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number023212
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number023212
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number023212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: