Provider Demographics
NPI:1154856441
Name:MELANCON, RAENEIKA
Entity Type:Individual
Prefix:
First Name:RAENEIKA
Middle Name:
Last Name:MELANCON
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 1:4751 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3243
Mailing Address - Country:US
Mailing Address - Phone:504-872-2129
Mailing Address - Fax:
Practice Address - Street 1:615 BARONNE ST STE 304
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1054
Practice Address - Country:US
Practice Address - Phone:504-814-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator