MEDICARE: MRS. AMY MELISSA CRYSTAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	016335-1	NY

General Provider Information

NPI Number	:	1518278746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY MELISSA CRYSTAL

Provider Business Mailing Address
First Line	:	2995 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1839
Country	:	US
Telephone Number	:	718-998-9959
Fax Number	:	718-375-2811

Provider Business Practice Location Address
First Line	:	2995 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1839
Country	:	US
Telephone Number	:	718-998-9959
Fax Number	:	718-375-2811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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