Provider Demographics
NPI:1386070605
Name:SUSSMAN, MELANIE
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 S HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-4315
Mailing Address - Country:US
Mailing Address - Phone:914-734-1359
Mailing Address - Fax:914-734-1638
Practice Address - Street 1:612 DEPEW STREET
Practice Address - Street 2:C/O WOODSIDE ELEMENTARY SCHOOL - WJCS PROGRAM
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-734-1359
Practice Address - Fax:914-734-1638
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program