Healthcare Provider Details

I. General information

NPI: 1194527796
Provider Name (Legal Business Name): MELISSA MORENO-MALETTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 YOAKUM PKWY APT 1515
ALEXANDRIA VA
22304-4039
US

IV. Provider business mailing address

307 YOAKUM PKWY APT 1515
ALEXANDRIA VA
22304-4039
US

V. Phone/Fax

Practice location:
  • Phone: 570-994-3127
  • Fax:
Mailing address:
  • Phone: 570-994-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: