Provider Demographics
NPI:1497183255
Name:SIMON, MELANIE (MS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2342
Mailing Address - Country:US
Mailing Address - Phone:516-867-5240
Mailing Address - Fax:
Practice Address - Street 1:150 N COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2342
Practice Address - Country:US
Practice Address - Phone:516-867-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007467-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist