Healthcare Provider Details

I. General information

NPI: 1750961538
Provider Name (Legal Business Name): DANIELLE NICOLE MELTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

IV. Provider business mailing address

411 WALNUT STREET PMB: 25542
GREEN COVE SPRINGS FL
32043
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax: 772-404-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5629
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: