Provider Demographics
NPI:1922364041
Name:SCOLA, MELANIE JEAN (LAC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JEAN
Last Name:SCOLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:JEAN
Other - Last Name:SAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:430 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3018
Mailing Address - Country:US
Mailing Address - Phone:631-682-7619
Mailing Address - Fax:
Practice Address - Street 1:430 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3018
Practice Address - Country:US
Practice Address - Phone:631-682-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 004756171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist