Provider Demographics
NPI:1801130240
Name:EDDY, MELISSA A
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:EDDY
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 1:8205 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6053
Mailing Address - Country:US
Mailing Address - Phone:716-626-2222
Mailing Address - Fax:716-626-2220
Practice Address - Street 1:8205 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6053
Practice Address - Country:US
Practice Address - Phone:716-626-2222
Practice Address - Fax:716-626-2220
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator