Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MT203518 | PA |
N | 2084N0402X | Child Neurologist | C1-0012581 | DE |
NPI | 1215374236 |
---|---|
Provider Name | Dr. Ana Melikishvili |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 01/07/2019 |