Healthcare Provider Details

I. General information

NPI: 1689370009
Provider Name (Legal Business Name): GABRIELA MELILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 NEW LOUDON RD
LATHAM NY
12110-6101
US

IV. Provider business mailing address

839 NEW LOUDON RD
LATHAM NY
12110-6101
US

V. Phone/Fax

Practice location:
  • Phone: 518-217-2751
  • Fax:
Mailing address:
  • Phone: 518-217-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098964
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: