Healthcare Provider Details

I. General information

NPI: 1871156448
Provider Name (Legal Business Name): MELODY NICOLE MINEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 ARIEL ST N STE A
SAINT PAUL MN
55109-2202
US

IV. Provider business mailing address

2399 ARIEL ST N STE A
MAPLEWOOD MN
55109-2202
US

V. Phone/Fax

Practice location:
  • Phone: 651-773-0354
  • Fax:
Mailing address:
  • Phone: 651-773-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: