Provider Demographics
NPI:1902002827
Name:MELTON, JAMEELAH AYESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMEELAH
Middle Name:AYESHA
Last Name:MELTON
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 1:508 CARNEGIE CENTER
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:919-349-1839
Mailing Address - Fax:
Practice Address - Street 1:530 W WEBB AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3706
Practice Address - Country:US
Practice Address - Phone:336-228-8316
Practice Address - Fax:336-227-9750
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007010562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200701056OtherMEDICAL LICENSE NUMBER