Provider Demographics
NPI:1417511296
Name:DEVINE, MELISSA J
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:DEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:J
Other - Last Name:GRECO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2714 STATE HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-4041
Mailing Address - Country:US
Mailing Address - Phone:518-736-5720
Mailing Address - Fax:
Practice Address - Street 1:2714 STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4041
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator