Provider Demographics
NPI:1225533870
Name:MELUNI, KASSANDRA HALEY (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:HALEY
Last Name:MELUNI
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SINGLE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2156
Mailing Address - Country:US
Mailing Address - Phone:315-440-4198
Mailing Address - Fax:
Practice Address - Street 1:195 BLACKBERRY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3047
Practice Address - Country:US
Practice Address - Phone:315-453-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027653-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist