Provider Demographics
NPI:1033481924
Name:FERNANDEZ-BISONO, MELINA
Entity Type:Individual
Prefix:MRS
First Name:MELINA
Middle Name:
Last Name:FERNANDEZ-BISONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 COCHRAN PL
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1828
Mailing Address - Country:US
Mailing Address - Phone:347-886-8974
Mailing Address - Fax:
Practice Address - Street 1:142 COCHRAN PL
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1828
Practice Address - Country:US
Practice Address - Phone:347-886-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist