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General NPI Number Information
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NPI Number | 1558031948
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Entity Type | Organization
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Legal Business Name | AVELINE PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 2553 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3021
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Country | US
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Telephone | 917-856-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 13 COVENTRY WAY
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City | GUILFORD
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State | CT
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Zip | 06437-1671
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Country | US
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Telephone | 917-856-7195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES H MELVIN
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Credential | APRN
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Telephone | 917-856-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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