Provider Demographics
NPI:1982014239
Name:LEMON, MELISSA J
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:LEMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 E 147TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1027
Mailing Address - Country:US
Mailing Address - Phone:216-313-4499
Mailing Address - Fax:619-353-2349
Practice Address - Street 1:3820 E 147TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1027
Practice Address - Country:US
Practice Address - Phone:216-313-4499
Practice Address - Fax:619-353-2349
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH46-5535164251E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program