Provider Demographics
NPI:1841240975
Name:MELDA, KEITH A (AUD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:MELDA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 GOV. G.C. PEERY HWY.
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-7465
Mailing Address - Fax:276-963-3507
Practice Address - Street 1:6719 GOV. G.C. PEERY HWY.
Practice Address - Street 2:SUITE 2500
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-964-7465
Practice Address - Fax:276-963-3507
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001330231H00000X
VA2101001673237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R16653Medicare UPIN