Provider Demographics
NPI:1801031794
Name:MERLO, CHARLOTTE TAYLOR (AUD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:TAYLOR
Last Name:MERLO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FROST MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILL NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11765-1102
Mailing Address - Country:US
Mailing Address - Phone:516-922-4100
Mailing Address - Fax:516-922-3889
Practice Address - Street 1:34 FROST MILL ROAD
Practice Address - Street 2:
Practice Address - City:MILL NECK
Practice Address - State:NY
Practice Address - Zip Code:11765
Practice Address - Country:US
Practice Address - Phone:516-922-4100
Practice Address - Fax:516-922-3889
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001806-1231H00000X
NY14000019020237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400150912Medicare PIN