Provider Demographics
NPI:1750830709
Name:ACOSTA, MELANIE MAY PO (MT-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MAY PO
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 LA CONNER DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5724
Mailing Address - Country:US
Mailing Address - Phone:917-378-6313
Mailing Address - Fax:
Practice Address - Street 1:510 LAWRENCE EXPY STE 221
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4016
Practice Address - Country:US
Practice Address - Phone:408-531-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08547225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist