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General NPI Number Information
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NPI Number | 1720379803
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Entity Type | Individual
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Provider Name | MELANIE ECUNG DEYSS MD
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Gender | Female
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 315 S MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12208-1707
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Country | US
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Telephone | 518-525-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 77 NEALY AVE 633RD MDG/SGHM
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-764-1308
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 296708
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 296708
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License Number State | NY
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