Provider Demographics
NPI:1588965123
Name:ELLIS EL, MELISSA KAYE (BA,MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:ELLIS EL
Suffix:
Gender:F
Credentials:BA,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 KEMPSVILLE RD
Mailing Address - Street 2:STE.2
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2723
Mailing Address - Country:US
Mailing Address - Phone:757-495-1451
Mailing Address - Fax:866-667-2490
Practice Address - Street 1:810 KEMPSVILLE RD
Practice Address - Street 2:STE.2
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2723
Practice Address - Country:US
Practice Address - Phone:757-495-1451
Practice Address - Fax:866-667-2490
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171000000XOther Service ProvidersMilitary Health Care Provider
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588965123Medicare NSC