Provider Demographics
NPI:1467518100
Name:DE JESUS QUINN, MELISSA YAHAIRA (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:YAHAIRA
Last Name:DE JESUS QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:YAHAIRA
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16019 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2370
Mailing Address - Country:US
Mailing Address - Phone:210-696-9292
Mailing Address - Fax:210-690-8815
Practice Address - Street 1:16019 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2370
Practice Address - Country:US
Practice Address - Phone:210-696-9292
Practice Address - Fax:210-690-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1870892084P0800X
TXN40112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry