Provider Demographics
NPI:1700507761
Name:ZELAYA, CHANEL MELISSA
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:MELISSA
Last Name:ZELAYA
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 1:801 N QUINCY ST STE 601
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1729
Mailing Address - Country:US
Mailing Address - Phone:667-668-2566
Mailing Address - Fax:
Practice Address - Street 1:801 N QUINCY ST STE 601
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1729
Practice Address - Country:US
Practice Address - Phone:667-668-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00024184520363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty