Healthcare Provider Details

I. General information

NPI: 1336702018
Provider Name (Legal Business Name): MELISSA ANN KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 4TH ST NW
WASHINGTON DC
20012-1901
US

IV. Provider business mailing address

6833 4TH ST NW
WASHINGTON DC
20012-1901
US

V. Phone/Fax

Practice location:
  • Phone: 202-729-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD500003385
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD500003385
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD500003385
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: