Provider Demographics
NPI:1780841650
Name:TANNENBAUM, MELISSA ANN (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1238
Mailing Address - Country:US
Mailing Address - Phone:415-621-1185
Mailing Address - Fax:415-621-0810
Practice Address - Street 1:2220 15TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1238
Practice Address - Country:US
Practice Address - Phone:415-621-1185
Practice Address - Fax:415-621-0810
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1007237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ15177ZMedicare UPIN