Provider Demographics
NPI:1477202356
Name:ANDERSON-CHAVARRIA, MELISSA (DO, PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ANDERSON-CHAVARRIA
Suffix:
Gender:F
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2036
Mailing Address - Country:US
Mailing Address - Phone:973-525-3758
Mailing Address - Fax:
Practice Address - Street 1:4160 JOHN R ST STE 1017
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2017
Practice Address - Country:US
Practice Address - Phone:973-525-3758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program