Healthcare Provider Details

I. General information

NPI: 1073134631
Provider Name (Legal Business Name): KYLEE Y MELVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258 MARYLAND AVE
HAGERSTOWN MD
21740-7244
US

IV. Provider business mailing address

PO BOX 360595
PITTSBURGH PA
15251-6595
US

V. Phone/Fax

Practice location:
  • Phone: 301-359-6427
  • Fax:
Mailing address:
  • Phone: 718-215-5311
  • Fax: 718-865-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: