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General NPI Number Information
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NPI Number | 1982982740
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Entity Type | Individual
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Provider Name | MELISSA L SALLUSTIO MS, MED, LBA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2011
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 6333 KOLTON DR
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City | ROME
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State | NY
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Zip | 13440-7506
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Country | US
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Telephone | 680-219-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 KOLTON DR
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City | ROME
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State | NY
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Zip | 13440-7506
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Country | US
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Telephone | 680-219-3458
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-0298
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-10-6743
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License Number State |
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