Provider Demographics
NPI:1801516307
Name:MAYER, MELISSA ANNE (MS ED)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:MAYER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:23 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFF STA
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4207
Mailing Address - Country:US
Mailing Address - Phone:631-807-6313
Mailing Address - Fax:
Practice Address - Street 1:23 COLONY RD
Practice Address - Street 2:
Practice Address - City:PORT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-4207
Practice Address - Country:US
Practice Address - Phone:631-807-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist