MEDICARE: MELISSA KAYE ELLIS EL B.A.,M.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171000000X	Military Health Care Provider
2	374U00000X	Home Health Aide
3	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1588965123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KAYE ELLIS EL B.A.,M.S.

Provider Business Mailing Address
First Line	:	810 KEMPSVILLE RD
Second Line	:	STE.2
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-2723
Country	:	US
Telephone Number	:	757-495-1451
Fax Number	:	866-667-2490

Provider Business Practice Location Address
First Line	:	810 KEMPSVILLE RD
Second Line	:	STE.2
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-2723
Country	:	US
Telephone Number	:	757-495-1451
Fax Number	:	866-667-2490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2010
Last Update Date	:	07/07/2014

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