Healthcare Provider Details

I. General information

NPI: 1952550386
Provider Name (Legal Business Name): MELANIE SARA KZIRIAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 CASTOR AVE
PHILADELPHIA PA
19152-2732
US

IV. Provider business mailing address

4726 BLAKISTON ST
PHILADELPHIA PA
19136-1515
US

V. Phone/Fax

Practice location:
  • Phone: 215-722-4111
  • Fax: 215-722-6136
Mailing address:
  • Phone: 215-335-7940
  • Fax: 215-335-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number00935
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: