Basic Information
Provider Information
NPI: 1386943660
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCACCHETTI
FirstName: MELANIE
MiddleName: BETH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SCORSE
OtherFirstName: MELANIE
OtherMiddleName: BETH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 21 BRIDGEWOOD DR
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146123701
CountryCode: US
TelephoneNumber: 5853346000
FaxNumber: 5853342858
Practice Location
Address1: 3399 WINTON RD S
Address2:  
City: ROCHESTER
State: NY
PostalCode: 146233057
CountryCode: US
TelephoneNumber: 5853346000
FaxNumber: 5853342858
Other Information
ProviderEnumerationDate: 03/25/2011
LastUpdateDate: 03/25/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X020821-1NYY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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