Provider Demographics
NPI:1952102741
Name:WILSON, MELISSA RAY
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAY
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NOVEMBER
Other - Middle Name:RAY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5155 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2624
Mailing Address - Country:US
Mailing Address - Phone:727-225-5921
Mailing Address - Fax:
Practice Address - Street 1:5155 7TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2624
Practice Address - Country:US
Practice Address - Phone:727-225-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant