Provider Demographics
NPI:1043573728
Name:PAEZ, MELANIA
Entity Type:Individual
Prefix:
First Name:MELANIA
Middle Name:
Last Name:PAEZ
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 1:625 E 141ST ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2315
Mailing Address - Country:US
Mailing Address - Phone:646-604-0206
Mailing Address - Fax:
Practice Address - Street 1:625 E 141ST ST APT 5B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2315
Practice Address - Country:US
Practice Address - Phone:646-604-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator