Provider Demographics
NPI:1417219528
Name:COSTANZO-MELLONE, HEATHER ANNE (MSED)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:COSTANZO-MELLONE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4313
Mailing Address - Country:US
Mailing Address - Phone:718-375-8586
Mailing Address - Fax:
Practice Address - Street 1:1746 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4313
Practice Address - Country:US
Practice Address - Phone:718-375-8586
Practice Address - Fax:
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
Yes174400000XOther Service ProvidersSpecialist