Healthcare Provider Details

I. General information

NPI: 1871802637
Provider Name (Legal Business Name): NANCY I MELENDEZ MPSYC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. VEGA REDONDA STREET 7774 KM 3.0
COMERIO PR
00782
US

IV. Provider business mailing address

PO BOX 34
COMERIO PR
00782-0034
US

V. Phone/Fax

Practice location:
  • Phone: 787-359-0091
  • Fax:
Mailing address:
  • Phone: 787-359-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3782
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: