Provider Demographics
NPI:1477701530
Name:MELO-KENNEDY, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MELO-KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 BROADWAY
Mailing Address - Street 2:APT # 3A
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1871
Mailing Address - Country:US
Mailing Address - Phone:718-545-2030
Mailing Address - Fax:
Practice Address - Street 1:5014 BROADWAY
Practice Address - Street 2:APT # 3A
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1871
Practice Address - Country:US
Practice Address - Phone:718-545-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254997164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse