Provider Demographics
NPI:1386915551
Name:CECERE, MELANIE LYNN
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:LYNN
Last Name:CECERE
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 1:9425 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-9795
Mailing Address - Country:US
Mailing Address - Phone:585-815-3398
Mailing Address - Fax:
Practice Address - Street 1:9425 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:NY
Practice Address - Zip Code:14005-9795
Practice Address - Country:US
Practice Address - Phone:585-815-3398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267030-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse