Provider Demographics
NPI:1538637509
Name:MELEADY-D'AMBROSIO, MICHELLE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MELEADY-D'AMBROSIO
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15631 THISTLE DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8767
Mailing Address - Country:US
Mailing Address - Phone:240-938-6115
Mailing Address - Fax:
Practice Address - Street 1:4101 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-4115
Practice Address - Country:US
Practice Address - Phone:301-829-0800
Practice Address - Fax:301-698-4693
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist