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General NPI Number Information
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NPI Number | 1669053393
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Entity Type | Individual
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Provider Name | CANDICE MELKERSON DO
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Gender | Female
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 8254 MAYFIELD RD STE 4
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City | CHESTERLAND
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State | OH
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Zip | 44026-2562
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Country | US
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Telephone | 440-729-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone |
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Fax |
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 34.016986
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34.016986
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License Number State | OH
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