Healthcare Provider Details

I. General information

NPI: 1083526669
Provider Name (Legal Business Name): DEANNA MARIE MELILLO-DEGIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 BANNISTER LN
LAWRENCE NY
11559-2103
US

IV. Provider business mailing address

8 TOMPKINS RD
SCARSDALE NY
10583-2816
US

V. Phone/Fax

Practice location:
  • Phone: 914-564-5867
  • Fax:
Mailing address:
  • Phone: 914-564-5867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: