Healthcare Provider Details

I. General information

NPI: 1285897215
Provider Name (Legal Business Name): MELISSA E SOREY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 ROUTE 206 # 111213
SOUTHAMPTON NJ
08088-3558
US

IV. Provider business mailing address

8 BRIARCLIFF RD
MARLTON NJ
08053-2906
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-0240
  • Fax: 609-291-8880
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberTP001923G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NN04324800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: