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General NPI Number Information
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NPI Number | 1962602698
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Entity Type | Individual
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Provider Name | MELODY J CLANCY M. AC, DOM
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 12/19/2009
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Provider Practice Location Address
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Address Line | 2 SORRENTO DR
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City | OSPREY
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State | FL
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Zip | 34229-9610
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Country | US
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Telephone | 941-586-4064
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Fax | 941-412-4719
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Provider Business Mailing Address
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Address Line | 209 RUBENS DR APT A
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City | NOKOMIS
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State | FL
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Zip | 34275-4254
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Country | US
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Telephone | 941-586-4064
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Fax | 941-412-4719
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 2422
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License Number State | FL
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