Healthcare Provider Details

I. General information

NPI: 1255163432
Provider Name (Legal Business Name): MELANIE TAYER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BENJAMIN FRANKLIN PKWY APT E515
PHILADELPHIA PA
19130-3764
US

IV. Provider business mailing address

4500 FRANKFORD AVE
PHILADELPHIA PA
19124-3602
US

V. Phone/Fax

Practice location:
  • Phone: 858-334-8594
  • Fax:
Mailing address:
  • Phone: 888-296-4742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP030423
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP030423
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030423
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: