Provider Demographics
NPI:1629602305
Name:O'MALLEY, MELISSA CLARE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CLARE
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:CLARE
Other - Last Name:LOHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:112 WINDHAM CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1749
Mailing Address - Country:US
Mailing Address - Phone:215-200-2399
Mailing Address - Fax:
Practice Address - Street 1:1 CAPITAL WAY
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2520
Practice Address - Country:US
Practice Address - Phone:609-303-4718
Practice Address - Fax:609-303-4132
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00104100237600000X, 231H00000X
NJ25MG00153200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YA00104100OtherAUDIOLOGY LICENSE
NJ25MG00153200OtherHEARING AID DISPENSING LICENSE