Healthcare Provider Details

I. General information

NPI: 1326646555
Provider Name (Legal Business Name): MRS. MELISSA SARAH WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 SUSSEX LN APT A
DELAWARE OH
43015-2934
US

IV. Provider business mailing address

1314 SUSSEX LN APT A
DELAWARE OH
43015-2934
US

V. Phone/Fax

Practice location:
  • Phone: 707-347-6165
  • Fax:
Mailing address:
  • Phone: 707-347-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number7802560
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: