Provider Demographics
NPI:1366861676
Name:MELENDEZ, JUSTINA N
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:N
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2639
Mailing Address - Country:US
Mailing Address - Phone:774-545-0320
Mailing Address - Fax:
Practice Address - Street 1:19 ELMWOOD ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2639
Practice Address - Country:US
Practice Address - Phone:774-545-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist