Provider Demographics
NPI:1780998393
Name:FASTABEND, MELANIE HARVEY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:HARVEY
Last Name:FASTABEND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5746
Mailing Address - Country:US
Mailing Address - Phone:434-420-0672
Mailing Address - Fax:434-200-4670
Practice Address - Street 1:1300 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5746
Practice Address - Country:US
Practice Address - Phone:434-420-0672
Practice Address - Fax:434-200-4670
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily