Provider Demographics
NPI:1457996670
Name:HANSON, SARIAKA MELISSA
Entity Type:Individual
Prefix:
First Name:SARIAKA
Middle Name:MELISSA
Last Name:HANSON
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 1:288 OCEAN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-4700
Mailing Address - Country:US
Mailing Address - Phone:216-212-5850
Mailing Address - Fax:
Practice Address - Street 1:310 BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2902
Practice Address - Country:US
Practice Address - Phone:508-862-0514
Practice Address - Fax:508-862-9184
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHYRP380M60635OtherANTHEM BLUE CROSS BLUE SHIELD