Provider Demographics
NPI:1134574262
Name:COLETTA, MELANIE JERILYN (AGACNP-BC; AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JERILYN
Last Name:COLETTA
Suffix:
Gender:F
Credentials:AGACNP-BC; AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31548 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1762
Mailing Address - Country:US
Mailing Address - Phone:734-904-8674
Mailing Address - Fax:
Practice Address - Street 1:1204 MAIN ST STE 576
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3787
Practice Address - Country:US
Practice Address - Phone:844-359-8363
Practice Address - Fax:833-929-3520
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016231363L00000X
NY432829363L00000X
MI4704215283363L00000X
IN71014908A363L00000X
VA0024185807363L00000X
IL209031775363L00000X
NJ26NJ14869100363L00000X
CT11716363L00000X
DCNP500016857363L00000X
PANPPA059439363L00000X
VT101.0138100363L00000X
FLAPRN11018483363L00000X
OHAPRN.CNP.0035577363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner