MEDICARE: MELISSA R BUNNER PH.D.

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	103G00000X	Clinical Neuropsychologist	3-0720	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700984242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA R BUNNER PH.D.

Provider Business Mailing Address
First Line	:	1500 W 38TH ST STE 23
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-6317
Country	:	US
Telephone Number	:	512-637-5865
Fax Number	:	737-215-8710

Provider Business Practice Location Address
First Line	:	711 W 38TH ST
Second Line	:	BLDG. F
City	:	AUSTIN
State	:	TX
Zip	:	78705-1121
Country	:	US
Telephone Number	:	512-458-6121
Fax Number	:	512-452-5567

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/01/2026

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