Provider Demographics
NPI:1417109109
Name:AMHAYES, MELEKTE
Entity Type:Individual
Prefix:
First Name:MELEKTE
Middle Name:
Last Name:AMHAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELEKTE
Other - Middle Name:
Other - Last Name:AMHAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:54 EARDLEY RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3055
Mailing Address - Country:US
Mailing Address - Phone:732-339-1224
Mailing Address - Fax:732-339-1224
Practice Address - Street 1:54 EARDLEY RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3055
Practice Address - Country:US
Practice Address - Phone:732-339-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00084500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant