Provider Demographics
NPI:1083021760
Name:FUCHS, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:FUCHS
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 1:201 E LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1771
Mailing Address - Country:US
Mailing Address - Phone:516-455-6096
Mailing Address - Fax:
Practice Address - Street 1:201 E LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1771
Practice Address - Country:US
Practice Address - Phone:516-455-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist