Provider Demographics
NPI:1164667465
Name:MELKONIAN, ANGELA (MA SLP CCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MELKONIAN
Suffix:
Gender:F
Credentials:MA SLP CCC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DELEO
Other - Last Name:MELKONIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-3392
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-3392
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012132-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist