Provider Demographics
NPI:1114724564
Name:SMITH, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15925 VAN AKEN BLVD APT 305E
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5383
Mailing Address - Country:US
Mailing Address - Phone:757-383-3148
Mailing Address - Fax:
Practice Address - Street 1:15925 VAN AKEN BLVD APT 305E
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5383
Practice Address - Country:US
Practice Address - Phone:757-383-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist