Provider Demographics
NPI:1053675223
Name:ESUA, MELVIS
Entity Type:Individual
Prefix:
First Name:MELVIS
Middle Name:
Last Name:ESUA
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 1:11235 OAK LEAF DR APT 216
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1330
Mailing Address - Country:US
Mailing Address - Phone:240-476-2756
Mailing Address - Fax:
Practice Address - Street 1:11235 OAK LEAF DR APT 216
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1330
Practice Address - Country:US
Practice Address - Phone:240-476-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide