Healthcare Provider Details

I. General information

NPI: 1750881835
Provider Name (Legal Business Name): MELISSA HURTADO AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 40TH ST RM 1403
NEW YORK NY
10018-8518
US

IV. Provider business mailing address

3943 64TH ST
WOODSIDE NY
11377-3650
US

V. Phone/Fax

Practice location:
  • Phone: 212-354-2360
  • Fax:
Mailing address:
  • Phone: 917-880-5209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00272941026659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: