Provider Demographics
NPI:1316380918
Name:MELTON, MEGAN DANIELLE (CST)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:DANIELLE
Last Name:MELTON
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 HUNT DR
Mailing Address - Street 2:4602
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-3253
Mailing Address - Country:US
Mailing Address - Phone:214-356-0949
Mailing Address - Fax:
Practice Address - Street 1:4229 HUNT DR
Practice Address - Street 2:4602
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-3253
Practice Address - Country:US
Practice Address - Phone:214-356-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130108246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist