Healthcare Provider Details

I. General information

NPI: 1518571140
Provider Name (Legal Business Name): MELISSA JANE DEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 PACKER ST
MCKEESPORT PA
15132-4939
US

IV. Provider business mailing address

1607 PACKER ST
MCKEESPORT PA
15132-4939
US

V. Phone/Fax

Practice location:
  • Phone: 412-901-4201
  • Fax:
Mailing address:
  • Phone: 412-901-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: