Healthcare Provider Details

I. General information

NPI: 1063830131
Provider Name (Legal Business Name): MELLENA GIDAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

10306 MERIDIAN AVE N APT 202
SEATTLE WA
98133-9445
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-7749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60682151
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60682151
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: