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NPI Code Detail

MEDICARE: MELISSA NICOLE EDDY-SIDES

MEDICARE: MELISSA NICOLE EDDY-SIDES
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
1235Z00000XSpeech-Language Pathologist2011022505MO

General Provider Information

NPI Number : 1285913558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA NICOLE EDDY-SIDES
Provider Business Mailing Address
First Line : 310 US HIGHWAY 61
Second Line :
City : NEW MADRID
State : MO
Zip : 63869-9753
Country : US
Telephone Number : 573-688-2161
Fax Number : 573-688-2169
Provider Business Practice Location Address
First Line : 310 US HIGHWAY 61
Second Line :
City : NEW MADRID
State : MO
Zip : 63869-9753
Country : US
Telephone Number : 573-688-2161
Fax Number : 573-688-2169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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Directions to “ MELISSA NICOLE EDDY-SIDES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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