Healthcare Provider Details

I. General information

NPI: 1912576927
Provider Name (Legal Business Name): MELISSA LABATE MS, CHES, FMCHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 RED VENTURES DR
FORT MILL SC
29707-5005
US

IV. Provider business mailing address

15 ABBY LN
BALLSTON LAKE NY
12019-1422
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-0567
  • Fax:
Mailing address:
  • Phone: 505-803-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: