Healthcare Provider Details

I. General information

NPI: 1992168462
Provider Name (Legal Business Name): MELINDA KELDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 COUNTY ROUTE 56
WURTSBORO NY
12790-3101
US

IV. Provider business mailing address

258 COUNTY ROUTE 56
WURTSBORO NY
12790-3101
US

V. Phone/Fax

Practice location:
  • Phone: 845-866-3227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number290770
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: