Healthcare Provider Details

I. General information

NPI: 1154795946
Provider Name (Legal Business Name): MELANIE ROSE DAULTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 KIETZKE LN STE 103
RENO NV
89511-2063
US

IV. Provider business mailing address

5420 KIETZKE LN STE 103
RENO NV
89511-2063
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-2300
  • Fax: 775-329-5514
Mailing address:
  • Phone: 775-329-2300
  • Fax: 775-329-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number29851
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: