Provider Demographics
NPI:1629434063
Name:COFFEY, MELISSA SHANNON (DPT)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SHANNON
Last Name:COFFEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2434
Mailing Address - Country:US
Mailing Address - Phone:631-991-3311
Mailing Address - Fax:631-991-3309
Practice Address - Street 1:155 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2434
Practice Address - Country:US
Practice Address - Phone:631-991-3311
Practice Address - Fax:631-991-3309
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist