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Individual
MS. MELANIE J LAKE
Active
Individual
MS. MELANIE J LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
007368
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02054451
—
NY
Enumeration date
05/15/2007
Last updated
02/13/2025
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