Provider Demographics
NPI:1235220195
Name:JOSE, MELYNDA MICHELLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:MICHELLE
Last Name:JOSE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EXCHANGE PLACE
Mailing Address - Street 2:21 WEST MAIN STREET, 3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2013
Mailing Address - Country:US
Mailing Address - Phone:203-574-3777
Mailing Address - Fax:
Practice Address - Street 1:1 EXCHANGE PL
Practice Address - Street 2:21 WEST MAIN STREET, 3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2013
Practice Address - Country:US
Practice Address - Phone:203-574-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000279231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter