Provider Demographics
NPI:1467636514
Name:BANDELE, MELISSA RENEE HARDIMON (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE HARDIMON
Last Name:BANDELE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19735 GERMANTOWN RD STE 310
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1231
Mailing Address - Country:US
Mailing Address - Phone:301-972-6444
Mailing Address - Fax:
Practice Address - Street 1:19735 GERMANTOWN RD STE 310
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1231
Practice Address - Country:US
Practice Address - Phone:301-972-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9239428363LF0000X
MDR237024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003072400Medicaid
FLA1466XMedicare PIN