=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750936274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMAR RAE MELIN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2019
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 HOSPITAL HILL RD STE 1400
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06069-2095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-364-7029
-----------------------------------------------------
Fax | 860-364-7079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 HOSPITAL HILL RD STE 1400
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06069-2095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-364-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 8894
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | F309284-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F309284-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------