Provider Demographics
NPI:1376935254
Name:STARKS, MELISSIA
Entity Type:Individual
Prefix:MS
First Name:MELISSIA
Middle Name:
Last Name:STARKS
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 1:60 CARLTON AVE APT 12C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2220
Mailing Address - Country:US
Mailing Address - Phone:718-681-8700
Mailing Address - Fax:
Practice Address - Street 1:60 CARLTON AVE APT 12C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2220
Practice Address - Country:US
Practice Address - Phone:718-681-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program