Provider Demographics
NPI:1033705462
Name:SAUDER, MELISSA SUE
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:SUE
Last Name:SAUDER
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 1:1801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2346
Mailing Address - Country:US
Mailing Address - Phone:937-339-3694
Mailing Address - Fax:937-339-4332
Practice Address - Street 1:1801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2303
Practice Address - Country:US
Practice Address - Phone:937-339-3694
Practice Address - Fax:937-339-4332
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5505104374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5505104Medicaid