Provider Demographics
NPI:1962602698
Name:CLANCY, MELODY J (M AC, DOM)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:J
Last Name:CLANCY
Suffix:
Gender:F
Credentials:M AC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:209 RUBENS DR APT A
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-4254
Mailing Address - Country:US
Mailing Address - Phone:941-586-4064
Mailing Address - Fax:941-412-4719
Practice Address - Street 1:2 SORRENTO DR
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9610
Practice Address - Country:US
Practice Address - Phone:941-586-4064
Practice Address - Fax:941-412-4719
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2422171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist