Healthcare Provider Details

I. General information

NPI: 1487499653
Provider Name (Legal Business Name): MELISSA STAFFELDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HARREL ST
MORRISVILLE VT
05661-8526
US

IV. Provider business mailing address

988 COLLEGE HL UNIT 4
JOHNSON VT
05656-9709
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-5026
  • Fax: 802-888-6393
Mailing address:
  • Phone: 802-735-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: