Healthcare Provider Details

I. General information

NPI: 1639320823
Provider Name (Legal Business Name): MELISSA RENFROW TAYLOR AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD STE C-1011
MEMPHIS TN
38120-2131
US

IV. Provider business mailing address

4880 SNICKERS DR
ARLINGTON TN
38002-8707
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-5682
  • Fax:
Mailing address:
  • Phone: 901-377-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1408
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1408
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1408
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: