Provider Demographics
NPI:1811222912
Name:CORNELL, MELISSA ANGELINA (MA, CCC, SLP-L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANGELINA
Last Name:CORNELL
Suffix:
Gender:F
Credentials:MA, CCC, SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1057
Mailing Address - Country:US
Mailing Address - Phone:315-435-4276
Mailing Address - Fax:
Practice Address - Street 1:220 W KENNEDY ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1057
Practice Address - Country:US
Practice Address - Phone:315-435-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012778-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist