Provider Demographics
NPI:1568724987
Name:MELVILLE-DYCE, BETTY ANN SUSAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:BETTY ANN
Middle Name:SUSAN
Last Name:MELVILLE-DYCE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:150 E 42ND ST
Mailing Address - Street 2:FL 10
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5612
Mailing Address - Country:US
Mailing Address - Phone:646-605-8119
Mailing Address - Fax:
Practice Address - Street 1:143 STERLING ST
Practice Address - Street 2:APT 3B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3433
Practice Address - Country:US
Practice Address - Phone:718-940-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily