Provider Demographics
NPI:1932913142
Name:WYNN-MELENDEZ, TUNISIA IRIS (APRN)
Entity type:Individual
Prefix:
First Name:TUNISIA
Middle Name:IRIS
Last Name:WYNN-MELENDEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1719
Mailing Address - Country:US
Mailing Address - Phone:860-961-0553
Mailing Address - Fax:
Practice Address - Street 1:189 MILE CREEK RD
Practice Address - Street 2:
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1719
Practice Address - Country:US
Practice Address - Phone:860-961-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.014450364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult