Provider Demographics
NPI:1326504341
Name:ESTRADA, MELADY (RN BSN)
Entity Type:Individual
Prefix:
First Name:MELADY
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 CALLE TREVI
Mailing Address - Street 2:URB ESTRANCIAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-688-0102
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE B
Practice Address - Street 2:URB HACIENDAS DEL REAL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-688-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR038616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse