MEDICARE: MELODY SANDERS RIC

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	101Y00000X	Counselor	0704014205	VA

General Provider Information

NPI Number	:	1952085557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY SANDERS RIC

Provider Business Mailing Address
First Line	:	5209 ELMHURST AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2241
Country	:	US
Telephone Number	:	757-285-0878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5209 ELMHURST AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2241
Country	:	US
Telephone Number	:	757-285-0878
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ MELODY SANDERS RIC” Practice Location

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