Healthcare Provider Details

I. General information

NPI: 1003413295
Provider Name (Legal Business Name): MELANIE LOUISE FIORILLO NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 N LITCHFIELD RD STE 200
GOODYEAR AZ
85395-1253
US

IV. Provider business mailing address

1650 N 87TH TER UNIT 1B
SCOTTSDALE AZ
85257-2475
US

V. Phone/Fax

Practice location:
  • Phone: 623-643-9598
  • Fax: 623-478-0960
Mailing address:
  • Phone: 734-674-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number20-1905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: