MEDICARE: MRS. MELISSA LYNN TERZULLI MSW

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	104100000X	Social Worker	P81736	NY

General Provider Information

NPI Number	:	1851672935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA LYNN TERZULLI MSW

Provider Business Mailing Address
First Line	:	2529 STATE ROUTE 48
Second Line	:
City	:	FULTON
State	:	NY
Zip	:	13069-4140
Country	:	US
Telephone Number	:	315-326-3555
Fax Number	:	315-326-3566

Provider Business Practice Location Address
First Line	:	98 N 2ND ST STE 100
Second Line	:
City	:	FULTON
State	:	NY
Zip	:	13069-1254
Country	:	US
Telephone Number	:	315-326-3555
Fax Number	:	315-326-3566

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

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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