Healthcare Provider Details

I. General information

NPI: 1487454161
Provider Name (Legal Business Name): MELISSA DIRUZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTENNIAL DR
PEABODY MA
01960-7938
US

IV. Provider business mailing address

13 GREENLAWN AVE
SALEM MA
01970-1809
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-1110
  • Fax: 978-535-5910
Mailing address:
  • Phone: 978-761-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2357512
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2357512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: