Healthcare Provider Details

I. General information

NPI: 1861310823
Provider Name (Legal Business Name): MELISSA POPADIUK PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 GAUNTLET WAY
SUFFOLK VA
23434-9164
US

IV. Provider business mailing address

320 GAUNTLET WAY
SUFFOLK VA
23434-9164
US

V. Phone/Fax

Practice location:
  • Phone: 757-354-4490
  • Fax:
Mailing address:
  • Phone: 757-354-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001243722
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: