Provider Demographics
NPI:1770713034
Name:MELENDEZ, CHRISTINA (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ARTIST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2324
Mailing Address - Country:US
Mailing Address - Phone:516-647-7107
Mailing Address - Fax:631-775-8718
Practice Address - Street 1:310 ARTIST LAKE DR
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2324
Practice Address - Country:US
Practice Address - Phone:516-647-7107
Practice Address - Fax:631-775-8718
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275045-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse