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General NPI Number Information
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NPI Number | 1700108685
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Entity Type | Individual
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Provider Name | STEPHEN GEORGE MELANCON PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 535 E 70TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-4823
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Country | US
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Telephone | 212-606-1513
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Fax | 281-274-8053
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Provider Business Mailing Address
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Address Line | PO BOX 29234
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City | NEW YORK
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State | NY
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Zip | 10087-9234
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Country | US
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Telephone | 212-606-1513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10711
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10711
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License Number State | TX
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