Provider Demographics
NPI:1851755920
Name:MCDANIEL, MELISSA SMITH (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SMITH
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5575 FRISCO SQUARE BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3309
Mailing Address - Country:US
Mailing Address - Phone:972-377-6553
Mailing Address - Fax:972-377-6453
Practice Address - Street 1:5575 FRISCO SQUARE BLVD STE 410
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3309
Practice Address - Country:US
Practice Address - Phone:972-377-6553
Practice Address - Fax:972-377-6453
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS5984207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program