Healthcare Provider Details

I. General information

NPI: 1962269167
Provider Name (Legal Business Name): MELISSA ROMAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LAKE FOREST BLVD STE F
NEW ORLEANS LA
70127-2609
US

IV. Provider business mailing address

1807 SW 89TH TER
MIRAMAR FL
33025-7612
US

V. Phone/Fax

Practice location:
  • Phone: 504-620-0500
  • Fax:
Mailing address:
  • Phone: 305-815-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: