Provider Demographics
NPI:1376706598
Name:NICHOLS, MELANIE MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MARIE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:MARIE
Other - Last Name:ESDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 311
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-590-9462
Mailing Address - Fax:410-590-9464
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 311
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-590-9462
Practice Address - Fax:410-590-9464
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01153237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416186600Medicaid
133699ZA2LMedicare PIN