Healthcare Provider Details

I. General information

NPI: 1609518224
Provider Name (Legal Business Name): MELISSA RUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 CORPORATION LN STE 300
VIRGINIA BEACH VA
23462-3477
US

IV. Provider business mailing address

4417 CORPORATION LN STE 300
VIRGINIA BEACH VA
23462-3477
US

V. Phone/Fax

Practice location:
  • Phone: 757-785-3338
  • Fax:
Mailing address:
  • Phone: 757-785-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133003889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: