Provider Demographics
NPI:1225302284
Name:FONTANEZ, MELANIA ELOISA (RN,CDE)
Entity Type:Individual
Prefix:MRS
First Name:MELANIA
Middle Name:ELOISA
Last Name:FONTANEZ
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3668
Mailing Address - Country:US
Mailing Address - Phone:845-787-4249
Mailing Address - Fax:845-787-4249
Practice Address - Street 1:4 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3668
Practice Address - Country:US
Practice Address - Phone:845-787-4249
Practice Address - Fax:845-787-4249
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357727-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator