Provider Demographics
NPI:1932306362
Name:GOLDBLATT, MELISSA FAYE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:FAYE
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1132
Mailing Address - Country:US
Mailing Address - Phone:703-684-1493
Mailing Address - Fax:
Practice Address - Street 1:6303 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5000
Practice Address - Country:US
Practice Address - Phone:703-914-8989
Practice Address - Fax:703-914-5494
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167398363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics