Basic Information
Provider Information | |||||||||
NPI: | 1881740215 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MELUCCI | ||||||||
FirstName: | MARYANN | ||||||||
MiddleName: | E. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARRANCA | ||||||||
OtherFirstName: | MARYANN | ||||||||
OtherMiddleName: | E. | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 31 OLD FARM HILL RD | ||||||||
Address2: |   | ||||||||
City: | NEWTOWN | ||||||||
State: | CT | ||||||||
PostalCode: | 064701147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2033641495 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 333 ROUTE 25A | ||||||||
Address2: | SUITE 225 | ||||||||
City: | ROCKY POINT | ||||||||
State: | NY | ||||||||
PostalCode: | 11778 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6317443671 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2007 | ||||||||
LastUpdateDate: | 02/18/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 49505 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
No ID Information.