Provider Demographics
NPI:1457778011
Name:POLOSKY, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:POLOSKY
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 1:1120 BRAUN RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3104
Mailing Address - Country:US
Mailing Address - Phone:724-880-6369
Mailing Address - Fax:
Practice Address - Street 1:1120 BRAUN RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-3104
Practice Address - Country:US
Practice Address - Phone:724-880-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency