Provider Demographics
NPI:1972748564
Name:DRAKE, MELISSA A
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5358 CLARKS PT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NY
Mailing Address - Zip Code:13650-2121
Mailing Address - Country:US
Mailing Address - Phone:315-938-5626
Mailing Address - Fax:
Practice Address - Street 1:5358 CLARKS PT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NY
Practice Address - Zip Code:13650-2121
Practice Address - Country:US
Practice Address - Phone:315-938-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007967-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist