Healthcare Provider Details

I. General information

NPI: 1578014700
Provider Name (Legal Business Name): MELISSA MAE CRONYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 SPRUCE ST
NORTH COLLINS NY
14111
US

IV. Provider business mailing address

3450 HOWARD RD LOT 107
HAMBURG NY
14075-2120
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax: 716-337-2723
Mailing address:
  • Phone: 716-258-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: