Healthcare Provider Details

I. General information

NPI: 1710947429
Provider Name (Legal Business Name): MELODY A ESPIRITU PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELODY D ALEONAR

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 VETERANS MEMORIAL HWY STE 8
RONKONKOMA NY
11779-7680
US

IV. Provider business mailing address

16 WOODLEIGH CT
HOLBROOK NY
11741-2821
US

V. Phone/Fax

Practice location:
  • Phone: 631-676-6324
  • Fax: 631-676-6327
Mailing address:
  • Phone: 631-207-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number016946-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: