Healthcare Provider Details

I. General information

NPI: 1932806338
Provider Name (Legal Business Name): MELISSA QUINONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 FILLY DR
INDIAN TRAIL NC
28079-5708
US

IV. Provider business mailing address

3004 FILLY DR
INDIAN TRAIL NC
28079-5708
US

V. Phone/Fax

Practice location:
  • Phone: 704-989-9284
  • Fax:
Mailing address:
  • Phone: 704-989-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number39160652
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: