Healthcare Provider Details

I. General information

NPI: 1154268456
Provider Name (Legal Business Name): MELANEE ANNE SUREPOGU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANEE ANNE CASTROVERDE RN

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 TREE OF HEAVEN WAY
NEWARK DE
19713-3040
US

IV. Provider business mailing address

400 TREE OF HEAVEN WAY
NEWARK DE
19713-3040
US

V. Phone/Fax

Practice location:
  • Phone: 732-406-9858
  • Fax:
Mailing address:
  • Phone: 732-406-9858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLG-0013875
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: