Provider Demographics
NPI:1154885143
Name:DODARO, MELISSA CONLEY
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CONLEY
Last Name:DODARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7636
Mailing Address - Country:US
Mailing Address - Phone:864-671-8164
Mailing Address - Fax:
Practice Address - Street 1:205 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-7636
Practice Address - Country:US
Practice Address - Phone:864-671-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator