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General NPI Number Information
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NPI Number | 1336728906
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Entity Type | Individual
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Provider Name | MELISSA JOHNNIDIS DO
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 10/26/2025
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Provider Practice Location Address
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Address Line | 66 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3344
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Country | US
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Telephone | 207-662-1310
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Fax | 475-275-7458
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Provider Business Mailing Address
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Address Line | 66 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3344
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Country | US
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Telephone | 207-662-1310
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Fax | 207-662-6348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DO4093
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License Number State | ME
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