Doctor Name: | MRS. MELISSA LISSETH TELLO BAZALAR |
NPI Number: | 1003199407 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | 020825 |
Business Practice Address: | 140 Pelham Rd Apt 6l New Rochelle, NY - 108053119 |
Business Phone Number: | 3476663485 |
Business Fax Number: | |
Mailing Address: | 140 Pelham Rd Apt 6l, NEW ROCHELLE |
State: | NY |
Postal Code: | 108053119 |
Phone Number: | 3476663485 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2011 |
NPI Last Update Date: | 01/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 020825 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |