Provider Demographics
NPI:1962885962
Name:MOLENDA, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOLENDA
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 1:1500 E TROPICANA AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-8314
Mailing Address - Country:US
Mailing Address - Phone:756-820-0207
Mailing Address - Fax:702-995-6509
Practice Address - Street 1:1500 E TROPICANA AVE STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8314
Practice Address - Country:US
Practice Address - Phone:775-682-0020
Practice Address - Fax:702-995-6509
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1962885962OtherNPPES