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General NPI Number Information
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NPI Number | 1861569477
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Entity Type | Individual
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Provider Name | JANINE ALIYA TIAGO DE MELO PHD
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Gender | Female
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1651 THIRD AVE SUITE 201
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City | NEW YORK
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State | NY
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Zip | 10128
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Country | US
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Telephone | 212-427-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 51 SEVENTH AVE SOUTH APT 5C
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City | NEW YORK
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State | NY
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Zip | 10014
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Country | US
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Telephone | 212-366-9349
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 0139751
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0139751
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License Number State | NY
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