Provider Demographics
NPI:1114280781
Name:GILCHRIST, MELISSA (MS ED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:COLLUMBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:326 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2727
Mailing Address - Country:US
Mailing Address - Phone:631-592-2868
Mailing Address - Fax:
Practice Address - Street 1:326 17TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2727
Practice Address - Country:US
Practice Address - Phone:631-592-2868
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 Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist