Provider Demographics
NPI:1326685959
Name:STAIE, MELINDA (LPN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:STAIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13343-4105
Mailing Address - Country:US
Mailing Address - Phone:315-681-7547
Mailing Address - Fax:
Practice Address - Street 1:6105 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GLENFIELD
Practice Address - State:NY
Practice Address - Zip Code:13343-4105
Practice Address - Country:US
Practice Address - Phone:315-681-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332823-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse