Healthcare Provider Details

I. General information

NPI: 1417874132
Provider Name (Legal Business Name): MELISSA VECCHIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18900 EUREKA RD
SOUTHGATE MI
48195-2985
US

IV. Provider business mailing address

6853 DEER RIDGE RD APT 65
MAUMEE OH
43537-8315
US

V. Phone/Fax

Practice location:
  • Phone: 734-290-8500
  • Fax:
Mailing address:
  • Phone: 330-275-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: