Provider Demographics
NPI:1487894317
Name:TRILLO, MELISSA RYAN (MS ED)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RYAN
Last Name:TRILLO
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 STARIN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2030
Mailing Address - Country:US
Mailing Address - Phone:716-316-7779
Mailing Address - Fax:
Practice Address - Street 1:780 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216
Practice Address - Country:US
Practice Address - Phone:716-816-3440
Practice Address - Fax:716-838-7448
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist