Provider Demographics
NPI:1407177520
Name:BURGER, MELINDA SUSAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SUSAN
Last Name:BURGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:SUSAN
Other - Last Name:BURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:574 BIRCH HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1029
Mailing Address - Country:US
Mailing Address - Phone:631-345-3299
Mailing Address - Fax:
Practice Address - Street 1:574 BIRCH HOLLOW DR
Practice Address - Street 2:
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967-1029
Practice Address - Country:US
Practice Address - Phone:631-345-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249246-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse