Healthcare Provider Details

I. General information

NPI: 1588965123
Provider Name (Legal Business Name): MELISSA KAYE ELLIS EL B.A.,M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2010
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 KEMPSVILLE RD STE.2
VIRGINIA BEACH VA
23464-2723
US

IV. Provider business mailing address

810 KEMPSVILLE RD STE.2
VIRGINIA BEACH VA
23464-2723
US

V. Phone/Fax

Practice location:
  • Phone: 757-495-1451
  • Fax: 866-667-2490
Mailing address:
  • Phone: 757-495-1451
  • Fax: 866-667-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: