Provider Demographics
NPI:1205196433
Name:FARIA, MELYSA SUE
Entity Type:Individual
Prefix:MS
First Name:MELYSA
Middle Name:SUE
Last Name:FARIA
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 1:1264 CHOPMIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1559
Mailing Address - Country:US
Mailing Address - Phone:401-230-6160
Mailing Address - Fax:
Practice Address - Street 1:1264 CHOPMIST HILL RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1559
Practice Address - Country:US
Practice Address - Phone:401-230-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2721116171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator