Provider Demographics
NPI:1669521092
Name:MEJIA, MELANIE MONCAYO (PT, MS)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MONCAYO
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045B PARK DR E
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1951
Mailing Address - Country:US
Mailing Address - Phone:347-561-7554
Mailing Address - Fax:347-561-7554
Practice Address - Street 1:258 E MEADOW AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2456
Practice Address - Country:US
Practice Address - Phone:516-222-2010
Practice Address - Fax:516-222-2011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018991-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ21J81Medicare ID - Type Unspecified