Provider Demographics
NPI:1366935710
Name:SULICH, MELANIE (ATC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SULICH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RITA DR
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4618
Mailing Address - Country:US
Mailing Address - Phone:203-942-7622
Mailing Address - Fax:
Practice Address - Street 1:125 ROUTE 340
Practice Address - Street 2:
Practice Address - City:SPARKILL
Practice Address - State:NY
Practice Address - Zip Code:10976-1041
Practice Address - Country:US
Practice Address - Phone:845-398-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer