Healthcare Provider Details

I. General information

NPI: 1508790627
Provider Name (Legal Business Name): MELISSA ANNE FERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 SCHIRRA DR
AMBLER PA
19002-4012
US

IV. Provider business mailing address

1437 SCHIRRA DR
AMBLER PA
19002-4012
US

V. Phone/Fax

Practice location:
  • Phone: 203-308-3775
  • Fax:
Mailing address:
  • Phone: 203-308-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN739036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: