Healthcare Provider Details

I. General information

NPI: 1598521940
Provider Name (Legal Business Name): MELISSA ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD COUNTRY RD STE C103N
WESTBURY NY
11590-5156
US

IV. Provider business mailing address

228 BAYVIEW DR
MASTIC BEACH NY
11951-4614
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-6969
  • Fax:
Mailing address:
  • Phone: 646-402-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1275482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: