Provider Demographics
NPI:1467207589
Name:FRY, MELISSA CATHLEEN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:CATHLEEN
Last Name:FRY
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 1:8341 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3810
Mailing Address - Country:US
Mailing Address - Phone:440-554-6731
Mailing Address - Fax:
Practice Address - Street 1:8341 CLOVER LN
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3810
Practice Address - Country:US
Practice Address - Phone:440-554-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant