Provider Demographics
NPI:1932711447
Name:SPAULDING, MELVIN DANIEL
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:DANIEL
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-0165
Mailing Address - Country:US
Mailing Address - Phone:304-421-4474
Mailing Address - Fax:
Practice Address - Street 1:711 FERRELL RD APT 202
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-7473
Practice Address - Country:US
Practice Address - Phone:304-421-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant