Healthcare Provider Details

I. General information

NPI: 1912700816
Provider Name (Legal Business Name): DEVIN MICHAEL MELANCON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PERDIDO ST RM 8119
NEW ORLEANS LA
70112-1352
US

IV. Provider business mailing address

504 MELODY DR
METAIRIE LA
70001-2116
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4748
  • Fax:
Mailing address:
  • Phone:
  • 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: