Provider Demographics
NPI:1841065703
Name:SIMON, MELODY LYNN
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
Last Name:SIMON
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 1:1342 STARDUST AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3162
Mailing Address - Country:US
Mailing Address - Phone:330-209-7458
Mailing Address - Fax:
Practice Address - Street 1:1342 STARDUST AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3162
Practice Address - Country:US
Practice Address - Phone:330-209-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker