Provider Demographics
NPI:1164840427
Name:HERRERA MELENDEZ, MAYLEN VICTORIA
Entity type:Individual
Prefix:
First Name:MAYLEN
Middle Name:VICTORIA
Last Name:HERRERA MELENDEZ
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 1:44 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4422
Mailing Address - Country:US
Mailing Address - Phone:347-720-3493
Mailing Address - Fax:
Practice Address - Street 1:12510 QUEENS BLVD STE 218
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1506
Practice Address - Country:US
Practice Address - Phone:718-593-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024492-01235Z00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program