Healthcare Provider Details

I. General information

NPI: 1184130148
Provider Name (Legal Business Name): MELISSA TIRADO CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CEDAR RUN APT T
ATLANTA GA
30350-2480
US

IV. Provider business mailing address

2 CEDAR RUN
ATLANTA GA
30350-2488
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-1544
  • Fax:
Mailing address:
  • Phone: 404-966-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberCN0014212290
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCN0014212290
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCN0014212290
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License NumberCN0014212290
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0014212290
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: