Healthcare Provider Details

I. General information

NPI: 1932410800
Provider Name (Legal Business Name): MELANIE CHARLES MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD SUITE 210
MINEOLA NY
11501-4064
US

IV. Provider business mailing address

222 STATION PLZ N SUITE 611
MINEOLA NY
11501-3800
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4600
  • Fax: 516-663-3070
Mailing address:
  • Phone: 516-663-2532
  • Fax: 516-663-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: