Provider Demographics
NPI:1730106246
Name:SALLAH, MELISSA COSTANZA (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:COSTANZA
Last Name:SALLAH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:COSTANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5311
Mailing Address - Country:US
Mailing Address - Phone:631-332-9089
Mailing Address - Fax:516-798-9070
Practice Address - Street 1:4200 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5311
Practice Address - Country:US
Practice Address - Phone:631-332-9089
Practice Address - Fax:516-798-9070
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00441Medicare UPIN
NYX7F821Medicare PIN