Provider Demographics
NPI:1053137372
Name:DOCKERY, MELLANIE SIMONE
Entity type:Individual
Prefix:
First Name:MELLANIE
Middle Name:SIMONE
Last Name:DOCKERY
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 1:3335 PRINCE EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3448
Mailing Address - Country:US
Mailing Address - Phone:202-556-7855
Mailing Address - Fax:
Practice Address - Street 1:3335 PRINCE EDWARD DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3448
Practice Address - Country:US
Practice Address - Phone:202-556-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant