Healthcare Provider Details

I. General information

NPI: 1366367492
Provider Name (Legal Business Name): MELISSA L DEJESUS RN BSN CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ASPEN LN
FREEHOLD NJ
07728-4129
US

IV. Provider business mailing address

7 ASPEN LN
FREEHOLD NJ
07728-4129
US

V. Phone/Fax

Practice location:
  • Phone: 732-864-4685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number26NR21366100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR21366100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: