Melissa L Sallustio, MS, MED, LBA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-10-6743

Practice address

6333 Kolton Dr
Rome, NY 13440-7506

Phone

(680) 219-3458

NPI assigned

Jul 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Melissa L Kotarski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education, Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Behavioral Ventures LLC

  • Behavior Analyst
  • Denver, CO
  • NPI 1124532718
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1982982740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 KOLTON DR",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134407506",
            "telephone_number": "680-219-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 KOLTON DR",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134407506",
            "telephone_number": "680-219-3458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1716 Briarcrest Dr Fl 3",
            "address_purpose": "LOCATION",
            "city": "Bryan",
            "state": "TX",
            "postal_code": "778022763",
            "country_code": "US",
            "telephone_number": "775-560-3345",
            "fax_number": "720-442-0193",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3420 E Shea Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850283348",
            "country_code": "US",
            "telephone_number": "775-560-3345",
            "fax_number": "720-442-0193",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8002 E 50th Dr",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802383299",
            "country_code": "US",
            "telephone_number": "775-560-3345",
            "fax_number": "720-442-0193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SALLUSTIO",
        "first_name": "MELISSA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MS, MED, LBA, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-28",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AZ",
            "license": "BA-0298",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-10-6743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "344158",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "KOTARSKI",
            "middle_name": "L",
            "credential": "MS, MED, LBA, BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in Rome, NY
• Providers in Rome, NY by specialty
• Behavior Analyst in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.