Provider Demographics
NPI:1104997493
Name:MILES, MELANIE (AUD)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:MILES
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 1:12 SHELART STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-349-1067
Mailing Address - Fax:516-349-1047
Practice Address - Street 1:12 SHELART ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1421
Practice Address - Country:US
Practice Address - Phone:516-349-1067
Practice Address - Fax:516-349-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001642-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist