Provider Demographics
NPI:1841865482
Name:MELICOR, ABIGAIL FUENTES (MD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:FUENTES
Last Name:MELICOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 LENOX AVENUE
Mailing Address - Street 2:MLK BUILDING 17-110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037
Mailing Address - Country:US
Mailing Address - Phone:212-939-4020
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVENUE
Practice Address - Street 2:MLK BUILDING 17-110
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-02-15
Deactivation Date:2022-11-16
Deactivation Code:
Reactivation Date:2023-02-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program