Provider Demographics
NPI:1275895088
Name:MELNYCZUK, CATHLEEN (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:
Last Name:MELNYCZUK
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4434
Mailing Address - Country:US
Mailing Address - Phone:516-454-6193
Mailing Address - Fax:516-486-0293
Practice Address - Street 1:1541 WILSON RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4434
Practice Address - Country:US
Practice Address - Phone:516-456-1934
Practice Address - Fax:516-485-0293
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist