Healthcare Provider Details

I. General information

NPI: 1750842308
Provider Name (Legal Business Name): MELANIE LEE DUNN SULLIVAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 7TH ST UNIT A
CHARLOTTE NC
28204-4398
US

IV. Provider business mailing address

PO BOX 96897
CHARLOTTE NC
28296-6897
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7900
  • Fax:
Mailing address:
  • Phone: 704-372-7900
  • Fax: 704-376-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011620
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: