Healthcare Provider Details

I. General information

NPI: 1154068005
Provider Name (Legal Business Name): MELODY RENE BRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PLANTERS RD APT 4C
MESQUITE TX
75182-9621
US

IV. Provider business mailing address

201 PLANTERS RD APT 4C
SUNNYVALE TX
75182-9621
US

V. Phone/Fax

Practice location:
  • Phone: 504-877-2648
  • Fax:
Mailing address:
  • Phone: 504-877-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: