Provider Demographics
NPI:1598136640
Name:REECE, MELISSA K (MSED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:REECE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 WILLOW RD W
Mailing Address - Street 2:2A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1654
Mailing Address - Country:US
Mailing Address - Phone:718-619-2169
Mailing Address - Fax:
Practice Address - Street 1:384 WILLOW RD W
Practice Address - Street 2:2A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1654
Practice Address - Country:US
Practice Address - Phone:718-619-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY849252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist