Provider Demographics
NPI:1295169613
Name:CHANDO, MELISSA ERIN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ERIN
Last Name:CHANDO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ERIN
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:51 N DUNLAP ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4625
Mailing Address - Country:US
Mailing Address - Phone:901-287-7337
Mailing Address - Fax:
Practice Address - Street 1:51 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4625
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18664363LF0000X
NC5006346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1295169613Medicaid
SCNP2585Medicaid
NCNCF605AMedicare PIN