Provider Demographics
NPI:1902280787
Name:GERENIA, MELANI (LICAC)
Entity Type:Individual
Prefix:
First Name:MELANI
Middle Name:
Last Name:GERENIA
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHAPIN RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2761
Mailing Address - Country:US
Mailing Address - Phone:774-314-2499
Mailing Address - Fax:
Practice Address - Street 1:106 W MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1824
Practice Address - Country:US
Practice Address - Phone:774-314-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist