Provider Demographics
NPI:1033695473
Name:BEACHAM, MELANIE JOSEPHINE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOSEPHINE
Last Name:BEACHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MARTIN LUTHER KING JR BLVD APT 1503
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1703
Mailing Address - Country:US
Mailing Address - Phone:330-502-8535
Mailing Address - Fax:
Practice Address - Street 1:940 MARTIN LUTHER KING JR BLVD APT 1503
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1703
Practice Address - Country:US
Practice Address - Phone:330-502-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide