Provider Demographics
NPI:1689282634
Name:SANDY, MELANIE L (M A, M S, BCBA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:SANDY
Suffix:
Gender:F
Credentials:M A, M S, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4310
Mailing Address - Country:US
Mailing Address - Phone:856-580-1005
Mailing Address - Fax:
Practice Address - Street 1:408 SHELDON DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4310
Practice Address - Country:US
Practice Address - Phone:856-580-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-23-70331103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician