Healthcare Provider Details

I. General information

NPI: 1114751674
Provider Name (Legal Business Name): MELISSA SPIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SPRUCE AVE
WILMINGTON DE
19805-2148
US

IV. Provider business mailing address

2 WINTERHAVEN DR APT 15
NEWARK DE
19702-2475
US

V. Phone/Fax

Practice location:
  • Phone: 302-992-5560
  • Fax:
Mailing address:
  • Phone: 215-510-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO1-0012118
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: