Provider Demographics
NPI:1093078800
Name:SANTIAGO, MELISSA A (MSED-TSSLD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MSED-TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4901
Mailing Address - Country:US
Mailing Address - Phone:718-405-7660
Mailing Address - Fax:
Practice Address - Street 1:3050 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4901
Practice Address - Country:US
Practice Address - Phone:718-405-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist