Healthcare Provider Details

I. General information

NPI: 1265336283
Provider Name (Legal Business Name): DAWNIRAY MELTON PEER SUPPORT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

192 POMEROY AVE
DAYTON OH
45417-8642
US

V. Phone/Fax

Practice location:
  • Phone: 800-829-5461
  • Fax:
Mailing address:
  • Phone: 800-829-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS008310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: