=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013888023
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA STANSBURY NBC-HWC, ACSM-EP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5716 MINERAL HILL RD
-----------------------------------------------------
City | ELDERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-6857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-802-3899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5716 MINERAL HILL RD
-----------------------------------------------------
City | ELDERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21784-6857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-802-3899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Y00000X
-----------------------------------------------------
Taxonomy Name | Clinical Exercise Physiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------