Healthcare Provider Details

I. General information

NPI: 1447921820
Provider Name (Legal Business Name): SHEMAYA MELISSA MARCEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 2ND AVE
SEATTLE WA
98101-3363
US

IV. Provider business mailing address

1714 SW CYCLE ST
PORT SAINT LUCIE FL
34953-1128
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9486402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: