Provider Demographics
NPI:1922092444
Name:MANN, MELINDA SUE (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:SUE
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 E 7TH ST
Mailing Address - Street 2:APT 1K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2246
Mailing Address - Country:US
Mailing Address - Phone:718-437-3131
Mailing Address - Fax:718-437-3089
Practice Address - Street 1:855 E 7TH ST
Practice Address - Street 2:APT 1K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2246
Practice Address - Country:US
Practice Address - Phone:718-437-3131
Practice Address - Fax:718-437-3089
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171092207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY171092OtherLICENSE
NY01244779Medicaid
NY01244779Medicaid
NY01244779Medicaid
NY171092OtherLICENSE