Healthcare Provider Details

I. General information

NPI: 1164857066
Provider Name (Legal Business Name): DANIELLE MELCHIONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 WILLIS AVE
WILLISTON PARK NY
11596-2298
US

IV. Provider business mailing address

51 STEWART AVE.
STEWART MANOR NY
11530
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-0729
  • Fax:
Mailing address:
  • Phone: 516-741-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: