Provider Demographics
NPI:1295036341
Name:MORELLI-WALSH, C. MELISSA (CNM, IBCLC)
Entity Type:Individual
Prefix:
First Name:C. MELISSA
Middle Name:
Last Name:MORELLI-WALSH
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 MADELINE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5807
Mailing Address - Country:US
Mailing Address - Phone:917-509-4907
Mailing Address - Fax:
Practice Address - Street 1:6816 MADELINE CT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5807
Practice Address - Country:US
Practice Address - Phone:917-509-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000930176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2152789Medicaid
NY2152789Medicaid
NYP23012Medicare UPIN