Healthcare Provider Details

I. General information

NPI: 1023858644
Provider Name (Legal Business Name): MELISSA DAVALOS SERNA AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 12/14/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 211
PROVO UT
84604-3374
US

IV. Provider business mailing address

1055 N 300 W STE 211
PROVO UT
84604-3374
US

V. Phone/Fax

Practice location:
  • Phone: 801-852-9684
  • Fax: 385-476-8446
Mailing address:
  • Phone: 801-852-9684
  • Fax: 385-476-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number13997896-4101
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number13997896-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: