Provider Demographics
NPI:1982175840
Name:NEALY, MELISSA GAYLE (IBCLC, CPM, LM)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
Last Name:NEALY
Suffix:
Gender:F
Credentials:IBCLC, CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 RIVER DELTA LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5790
Mailing Address - Country:US
Mailing Address - Phone:832-439-9838
Mailing Address - Fax:
Practice Address - Street 1:1305 FM 359 RD STE G
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2024
Practice Address - Country:US
Practice Address - Phone:832-439-9838
Practice Address - Fax:346-857-0515
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
TX99507176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN