Individual
MS. MELISSA L SALLUSTIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, MED, LBA, BCBA
Contact information
Practice address
6333 KOLTON DR, ROME, NY 13440-7506
(680) 219-3458
Mailing address
6333 KOLTON DR, ROME, NY 13440-7506
(680) 219-3458
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-10-6743
—
103K00000X
Behavior Analyst
BA-0298
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
344158
—
AZ
Enumeration date
07/28/2011
Last updated
09/15/2021
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