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NPI Code Detail

MEDICARE: DR. MELVIN F. NOSANCHUK PH.D.

MEDICARE: DR. MELVIN F. NOSANCHUK PH.D.
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
1103TC0700XClinical Psychologist106465-2501UT

General Provider Information

NPI Number : 1265467831
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELVIN F. NOSANCHUK PH.D.
Provider Business Mailing Address
First Line : 1646 KENSINGTON AVE
Second Line :
City : SLC
State : UT
Zip : 84105-2806
Country : US
Telephone Number : 801-467-4875
Fax Number : 801-467-4875
Provider Business Practice Location Address
First Line : 1646 KENSINGTON AVE
Second Line :
City : SLC
State : UT
Zip : 84105-2806
Country : US
Telephone Number : 801-467-4875
Fax Number : 801-467-4875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 09/06/2023

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