Healthcare Provider Details

I. General information

NPI: 1568373421
Provider Name (Legal Business Name): MELLISSA LEEANNE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 FALLS OF NEUSE RD STE 127
RALEIGH NC
27614-8239
US

IV. Provider business mailing address

1100 SAVANNAH CHASE CIR APT 208
GARNER NC
27529-5215
US

V. Phone/Fax

Practice location:
  • Phone: 252-626-8174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: