MEDICARE: MELISSA DIANE BERRYMAN

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	261QM2500X	Medical Specialty Clinic/Center	NPCN-17565-15013	VA
2	246RM2200X	Medical Laboratory Technician	NPCN-17565-15013	VA

General Provider Information

NPI Number	:	1154256675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DIANE BERRYMAN

Provider Business Mailing Address
First Line	:	617 WESTOVER HILLS BLVD APT E
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4538
Country	:	US
Telephone Number	:	804-629-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 WESTOVER HILLS BLVD APT E
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-4538
Country	:	US
Telephone Number	:	804-629-3558
Fax Number	:

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

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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Directions to “ MELISSA DIANE BERRYMAN ” Practice Location

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