Provider Demographics
NPI:1184988255
Name:ODELEYE, MELANIE E (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:E
Last Name:ODELEYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 METRO CENTER BLVD
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 METRO CENTER BLVD
Practice Address - Street 2:BUILDING 3
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2173
Practice Address - Country:US
Practice Address - Phone:650-409-1234
Practice Address - Fax:650-338-1166
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1344282083P0500X
AZR73353208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ835967Medicaid