MEDICARE: MELONIECE DUKES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1215817549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELONIECE DUKES LLC

Provider Business Mailing Address
First Line	:	110 E SHIRE CT
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-6111
Country	:	US
Telephone Number	:	480-514-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E SHIRE CT
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-6111
Country	:	US
Telephone Number	:	480-514-6200
Fax Number	:

Authorized Official
Title or Position	:	TRICHOLOGIST
Name	:	MELONIECE M DUKES
Credential	:
Telephone Number	:	480-514-6200

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	09/05/2025

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