Healthcare Provider Details

I. General information

NPI: 1205280864
Provider Name (Legal Business Name): JACLYN MELANIE DOVICO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 N ELM ST STE C
GREENSBORO NC
27455-2778
US

IV. Provider business mailing address

3818 N ELM ST STE C
GREENSBORO NC
27455-2778
US

V. Phone/Fax

Practice location:
  • Phone: 336-510-8553
  • Fax: 336-916-1784
Mailing address:
  • Phone: 336-510-8553
  • Fax: 336-916-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019-01681
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: