Provider Demographics
NPI:1760655393
Name:FEDORIS, MELINDA STUPAR (MSED)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:STUPAR
Last Name:FEDORIS
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:M
Other - Last Name:STUPAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:1803 WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-2572
Mailing Address - Country:US
Mailing Address - Phone:412-368-3535
Mailing Address - Fax:412-326-0210
Practice Address - Street 1:1803 WEST ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-2572
Practice Address - Country:US
Practice Address - Phone:412-368-3535
Practice Address - Fax:412-326-0210
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health