Provider Demographics
NPI:1760913255
Name:MELENDEZ, DAISY (MD)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 CONSTITUTION WAY
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4919
Mailing Address - Country:US
Mailing Address - Phone:845-391-7694
Mailing Address - Fax:
Practice Address - Street 1:2503 CONSTITUTION WAY
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4919
Practice Address - Country:US
Practice Address - Phone:845-391-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505951041172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker