| Doctor Name: | MARIO MELIDONA |
| NPI Number: | 1144229451 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 010148 |
| Business Practice Address: | 4188 Lakeville Rd Geneseo, NY - 144541134 |
| Business Phone Number: | 5852439150 |
| Business Fax Number: | 5852434814 |
| Mailing Address: | 4188 Lakeville Rd, GENESEO |
| State: | NY |
| Postal Code: | 144541134 |
| Phone Number: | 5852439150 |
| Fax Number: | 5852434814 |
| NPI Enumeration Date: | 07/19/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/20/2006 |
| NPI Reactivation Date: | 04/05/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 010148 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |