Healthcare Provider Details

I. General information

NPI: 1437931557
Provider Name (Legal Business Name): MELINA BUENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST STE B
GOSHEN NY
10924-1636
US

IV. Provider business mailing address

4 EDWARD DIANA WAY APT 59
MIDDLETOWN NY
10941-1834
US

V. Phone/Fax

Practice location:
  • Phone: 845-458-8661
  • Fax:
Mailing address:
  • Phone: 845-645-9731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: