Provider Demographics
NPI:1184868424
Name:TYO, MELINDA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ANN
Last Name:TYO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:ANN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:42 TORREY PINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2986
Mailing Address - Country:US
Mailing Address - Phone:585-329-6373
Mailing Address - Fax:
Practice Address - Street 1:42 TORREY PINE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2986
Practice Address - Country:US
Practice Address - Phone:585-329-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290996-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse