Individual
MELISSA FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 FAWN LN E, SOUTH SETAUKET, NY 11720-1329
(631) 896-0281
Mailing address
140 FAWN LANE EAST, SOUTH SETAUKET, NY 11720
(631) 896-0281
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
NY
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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