Provider Demographics
NPI:1568503001
Name:MAKI, MELISSA LYN (LAC, AP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LYN
Last Name:MAKI
Suffix:
Gender:F
Credentials:LAC, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-0805
Mailing Address - Country:US
Mailing Address - Phone:802-349-6295
Mailing Address - Fax:
Practice Address - Street 1:70 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2832
Practice Address - Country:US
Practice Address - Phone:802-349-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005095171100000X
FLAP 3224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist