Individual
TATIANA MELNIKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1565 E 14TH ST APT 6G, BROOKLYN, NY 11230-7156
(718) 708-9315
Mailing address
1565 E 14TH ST APT 6G, BROOKLYN, NY 11230-7156
(718) 708-9315
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1199439
NY
390200000X
Student in an Organized Health Care Education/Training Program
1199439
NY
Other
Enumeration date
11/28/2023
Last updated
11/28/2023
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