Provider Demographics
NPI:1134945710
Name:DAVOULAS, MELISSA (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DAVOULAS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13335-3200
Mailing Address - Country:US
Mailing Address - Phone:607-643-2493
Mailing Address - Fax:
Practice Address - Street 1:5590 BEAR RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1649
Practice Address - Country:US
Practice Address - Phone:315-218-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033661235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist