Provider Demographics
NPI:1811772239
Name:AZOULAY, MELISSA (MT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:AZOULAY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12833 NEWCASTLE WAY UNIT 411
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1452
Mailing Address - Country:US
Mailing Address - Phone:206-356-4409
Mailing Address - Fax:
Practice Address - Street 1:12833 NEWCASTLE WAY UNIT 411
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1452
Practice Address - Country:US
Practice Address - Phone:206-356-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.60311991225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist