MEDICARE: TIFFANY CARISE MELTON COSMETOLOGIST/PHT

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	332B00000X	Durable Medical Equipment & Medical Supplies	1159446	TX

General Provider Information

NPI Number	:	1194676650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY CARISE MELTON COSMETOLOGIST/PHT

Provider Business Mailing Address
First Line	:	539 W COMMERCE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-1953
Country	:	US
Telephone Number	:	512-296-3477
Fax Number	:

Provider Business Practice Location Address
First Line	:	9300 S INTERSTATE 35 STE 31
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-1733
Country	:	US
Telephone Number	:	512-296-3477
Fax Number	:	512-920-2302

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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