Provider Demographics
NPI:1760491807
Name:MELENDEZ, MAYDA (MD)
Entity Type:Individual
Prefix:
First Name:MAYDA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W 4TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3367
Mailing Address - Country:US
Mailing Address - Phone:302-482-3388
Mailing Address - Fax:302-482-3389
Practice Address - Street 1:2500 W 4TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3367
Practice Address - Country:US
Practice Address - Phone:302-482-3388
Practice Address - Fax:302-482-3389
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000939801OtherDELAWARE PHYSICNS
292961OtherALLIANCE
DEG91563OtherBCBS OF DE
DE0000939801Medicaid
510064326OtherAETNA US HEALTHCARE
62034OtherCOVENTRY
0373923000OtherAMER HEALTH
DEG91563OtherBCBS OF DE
DE0000939801Medicaid