Provider Demographics
NPI:1689095853
Name:FERNANDI, MELANIE (LAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FERNANDI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 E 102ND ST
Mailing Address - Street 2:APT D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5713
Mailing Address - Country:US
Mailing Address - Phone:917-399-7397
Mailing Address - Fax:
Practice Address - Street 1:1395 LEXINGTON AVE
Practice Address - Street 2:MEZZANINE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1612
Practice Address - Country:US
Practice Address - Phone:646-707-0400
Practice Address - Fax:646-707-0380
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3507-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3507-1OtherOFFICE OF THE PROFESSIONS, LICENSED ACUPUNCTURIST