Provider Demographics
NPI:1134604788
Name:MELVIN, SONIA
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MELVIN
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 1:77 LORRAINE TER APT 335
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1236
Mailing Address - Country:US
Mailing Address - Phone:914-751-4781
Mailing Address - Fax:
Practice Address - Street 1:77 LORRAINE TER APT 335
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1236
Practice Address - Country:US
Practice Address - Phone:914-751-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse