Provider Demographics
NPI:1457927774
Name:TIFANG, MELODIA
Entity type:Individual
Prefix:
First Name:MELODIA
Middle Name:
Last Name:TIFANG
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 1:11748 S LAUREL DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2956
Mailing Address - Country:US
Mailing Address - Phone:701-739-9253
Mailing Address - Fax:
Practice Address - Street 1:11748 S LAUREL DR APT 1C
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2956
Practice Address - Country:US
Practice Address - Phone:701-739-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide