Provider Demographics
NPI:1972670388
Name:MELTON, TANYA DANIELLA (PERSONALCARESERVICES)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DANIELLA
Last Name:MELTON
Suffix:
Gender:F
Credentials:PERSONALCARESERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 RED STONE CT
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-9407
Mailing Address - Country:US
Mailing Address - Phone:919-641-5722
Mailing Address - Fax:800-693-5742
Practice Address - Street 1:988 RED STONE CT
Practice Address - Street 2:
Practice Address - City:ROUGEMONT
Practice Address - State:NC
Practice Address - Zip Code:27572-9407
Practice Address - Country:US
Practice Address - Phone:919-641-5722
Practice Address - Fax:800-693-5742
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3519163WH0200X, 374U00000X, 133VN1004X, 390200000X
372500000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601585Medicaid
NC3418248Medicaid