Provider Demographics
NPI:1972935278
Name:CERVONE, MELISSA (MS, CFY-SLP)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:
Last Name:CERVONE
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 JIMMY DURANTE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2258
Mailing Address - Country:US
Mailing Address - Phone:858-509-1131
Mailing Address - Fax:858-509-1151
Practice Address - Street 1:2002 JIMMY DURANTE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2258
Practice Address - Country:US
Practice Address - Phone:858-509-1131
Practice Address - Fax:858-509-1151
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist