Provider Demographics
NPI:1750881835
Name:HURTADO, MELISSA (AUD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3650
Mailing Address - Country:US
Mailing Address - Phone:917-880-5209
Mailing Address - Fax:
Practice Address - Street 1:110 W 40TH ST RM 1403
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8518
Practice Address - Country:US
Practice Address - Phone:212-354-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00272941026659231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist