Healthcare Provider Details

I. General information

NPI: 1255789020
Provider Name (Legal Business Name): MELISSA MEJIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA AGOSTINI

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 AVENUE C APT 3B
NEW YORK NY
10009-6977
US

IV. Provider business mailing address

80 AVENUE C APT 3B
NEW YORK NY
10009-6977
US

V. Phone/Fax

Practice location:
  • Phone: 929-246-9365
  • Fax:
Mailing address:
  • Phone: 929-246-9365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number096386-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: