Healthcare Provider Details

I. General information

NPI: 1295639102
Provider Name (Legal Business Name): MELISSA THOMAS
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

940 BRYN MAWR AVE
YOUNGSTOWN OH
44505-4277
US

IV. Provider business mailing address

940 BRYN MAWR AVE
YOUNGSTOWN OH
44505-4277
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-7155
  • Fax: 330-743-1157
Mailing address:
  • Phone: 330-744-7155
  • Fax: 330-743-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.136273.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: