Provider Demographics
NPI:1265900534
Name:MACCHIO, MELLISA
Entity type:Individual
Prefix:
First Name:MELLISA
Middle Name:
Last Name:MACCHIO
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 1:1 FENCE LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3015
Mailing Address - Country:US
Mailing Address - Phone:631-513-3493
Mailing Address - Fax:
Practice Address - Street 1:1 FENCE LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3015
Practice Address - Country:US
Practice Address - Phone:631-513-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist