Healthcare Provider Details

I. General information

NPI: 1740197102
Provider Name (Legal Business Name): CAROL ANN MELDRIM
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 E FAYETTE ST
SYRACUSE NY
13210-1022
US

IV. Provider business mailing address

2090 DEER RUN RD
LA FAYETTE NY
13084-9585
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-3431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: