Provider Demographics
NPI:1710592258
Name:COLEMAN, MELISSA C
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:C
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38380 NORTH LN APT F109
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7461
Mailing Address - Country:US
Mailing Address - Phone:216-744-0489
Mailing Address - Fax:
Practice Address - Street 1:38380 NORTH LN APT F109
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7461
Practice Address - Country:US
Practice Address - Phone:216-744-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health