Provider Demographics
NPI:1598414625
Name:DEGREGORIO, MELISSA MONICA (MCD, MCPD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MONICA
Last Name:DEGREGORIO
Suffix:
Gender:F
Credentials:MCD, MCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283B NEW MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6419
Mailing Address - Country:US
Mailing Address - Phone:609-418-5046
Mailing Address - Fax:
Practice Address - Street 1:283B NEW MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6419
Practice Address - Country:US
Practice Address - Phone:609-418-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7449-16374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ873857169Medicaid