Provider Demographics
NPI:1437615283
Name:MARTIN, MELINDA DIANE (SEIS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DIANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:SEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:TIVOLI
Mailing Address - State:NY
Mailing Address - Zip Code:12583-5430
Mailing Address - Country:US
Mailing Address - Phone:845-518-5568
Mailing Address - Fax:
Practice Address - Street 1:268 W SAUGERTIES RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-3142
Practice Address - Country:US
Practice Address - Phone:845-247-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)