MEDICARE: MELINDA ARMSTEAD MS, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084P0804X	Child & Adolescent Psychiatry Physician	A165164	CA

General Provider Information

NPI Number	:	1073046199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA ARMSTEAD MS, MD

Provider Business Mailing Address
First Line	:	1702 MERIDIAN AVE STE L-196
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1460 CHERRY AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3801
Country	:	US
Telephone Number	:	916-734-2972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	09/24/2023

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