Provider Demographics
NPI:1689025439
Name:MORONE SOMMER, MELISSA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MORONE SOMMER
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3735
Mailing Address - Country:US
Mailing Address - Phone:203-536-7394
Mailing Address - Fax:
Practice Address - Street 1:825 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-5419
Practice Address - Country:US
Practice Address - Phone:203-536-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT660171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist