Provider Demographics
NPI:1558647131
Name:MORAN, MELANIE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:A
Last Name:MORAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1366
Mailing Address - Country:US
Mailing Address - Phone:518-719-3622
Mailing Address - Fax:518-719-3779
Practice Address - Street 1:411 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1366
Practice Address - Country:US
Practice Address - Phone:518-719-3600
Practice Address - Fax:518-719-3779
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY533683163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1114056777Medicaid