Healthcare Provider Details

I. General information

NPI: 1235055013
Provider Name (Legal Business Name): MELISSA TELLERIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CLIFF ST
JERSEY CITY NJ
07306-3411
US

IV. Provider business mailing address

20 CLIFF ST
JERSEY CITY NJ
07306-3411
US

V. Phone/Fax

Practice location:
  • Phone: 551-655-9696
  • Fax:
Mailing address:
  • Phone: 551-655-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00788600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: