Provider Demographics
NPI:1255190229
Name:MELENDEZ, VANESSA SARAHI
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:SARAHI
Last Name:MELENDEZ
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 1:10521 W LA REATA AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-4660
Mailing Address - Country:US
Mailing Address - Phone:602-358-3398
Mailing Address - Fax:
Practice Address - Street 1:12409 W INDIAN SCHOOL RD STE C312
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9510
Practice Address - Country:US
Practice Address - Phone:623-471-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services