Provider Demographics
NPI:1760243554
Name:HARRIS, MELISSA D'ANDREA (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D'ANDREA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CARROLL TER
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1703
Mailing Address - Country:US
Mailing Address - Phone:518-410-8880
Mailing Address - Fax:
Practice Address - Street 1:12 CARROLL TER
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1703
Practice Address - Country:US
Practice Address - Phone:518-410-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY436801Medicaid