Provider Demographics
NPI:1528229044
Name:TYE, MELODY LAVONNE (STNA)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:LAVONNE
Last Name:TYE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2935
Mailing Address - Country:US
Mailing Address - Phone:513-381-1344
Mailing Address - Fax:513-381-2607
Practice Address - Street 1:3470 HARVEY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2935
Practice Address - Country:US
Practice Address - Phone:513-381-1344
Practice Address - Fax:513-381-2607
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400642980707376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2809992Medicaid