Provider Demographics
NPI:1396007654
Name:MELZER, RANDI LYNN (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:LYNN
Last Name:MELZER
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 1:10 WYNGATE PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2521
Mailing Address - Country:US
Mailing Address - Phone:516-482-8894
Mailing Address - Fax:516-482-5394
Practice Address - Street 1:10 WYNGATE PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2521
Practice Address - Country:US
Practice Address - Phone:516-482-8894
Practice Address - Fax:516-482-5394
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor