Provider Demographics
NPI:1790118156
Name:TAYLOR, MELISSA ANN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-245-6957
Mailing Address - Fax:302-645-4801
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4474
Practice Address - Country:US
Practice Address - Phone:302-645-4801
Practice Address - Fax:302-645-7183
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000675363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEAN-0009415OtherCONTROLLED SUBSTANCES
DEL1-0035586OtherNURSING LICENSE
DELG-0000675OtherLICENSE