MEDICARE: MISS ODALIS MELENDEZ LMT

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	225700000X	Massage Therapist	026642-01	NY

General Provider Information

NPI Number	:	1710683883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ODALIS MELENDEZ LMT

Provider Business Mailing Address
First Line	:	22205 56TH AVE # MC09
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-1432
Country	:	US
Telephone Number	:	917-645-6592
Fax Number	:

Provider Business Practice Location Address
First Line	:	22205 56TH AVE # MC09
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-1432
Country	:	US
Telephone Number	:	917-645-6592
Fax Number	:

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	01/15/2026

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