Healthcare Provider Details

I. General information

NPI: 1861569477
Provider Name (Legal Business Name): JANINE ALIYA TIAGO DE MELO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANINE A TIAGO PHD

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 THIRD AVE SUITE 201
NEW YORK NY
10128
US

IV. Provider business mailing address

51 SEVENTH AVE SOUTH APT 5C
NEW YORK NY
10014
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-4044
  • Fax:
Mailing address:
  • Phone: 212-366-9349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0139751
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0139751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: