Healthcare Provider Details

I. General information

NPI: 1205962446
Provider Name (Legal Business Name): MELISSA P RASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 UPTON DR
SOUND BEACH NY
11789-2133
US

IV. Provider business mailing address

55 UPTON DR
SOUND BEACH NY
11789-2133
US

V. Phone/Fax

Practice location:
  • Phone: 631-821-7813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: