Provider Demographics
NPI:1629347745
Name:RALLO, MELISSA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:RALLO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 DUNDERBERG RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3507
Mailing Address - Country:US
Mailing Address - Phone:845-460-6400
Mailing Address - Fax:
Practice Address - Street 1:199 DUNDERBERG RD
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3507
Practice Address - Country:US
Practice Address - Phone:845-460-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY466461-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY154431Medicaid