Healthcare Provider Details

I. General information

NPI: 1053928853
Provider Name (Legal Business Name): MELISSA MILLER MS, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14877 W BELL RD STE 101
SURPRISE AZ
85374-7610
US

IV. Provider business mailing address

14877 W BELL RD STE 101
SURPRISE AZ
85374-7610
US

V. Phone/Fax

Practice location:
  • Phone: 623-234-4640
  • Fax: 623-234-4642
Mailing address:
  • Phone: 623-234-4640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA4746
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: