MEDICARE: MRS. MARINA MELLON MS, CCC-SLP/TSSLD

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	022192	NY

General Provider Information

NPI Number	:	1699026807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARINA MELLON MS, CCC-SLP/TSSLD

Provider Business Mailing Address
First Line	:	400 DOANSBURG RD # 719
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-5902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 DOANSBURG ROAD
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-0719
Country	:	US
Telephone Number	:	845-279-2995
Fax Number	:

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

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	03/23/2016

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