Provider Demographics
NPI:1144061540
Name:LEONG, MELISSA SHU
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SHU
Last Name:LEONG
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 1:8845 MD BUSH DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-1338
Mailing Address - Country:US
Mailing Address - Phone:415-819-4203
Mailing Address - Fax:
Practice Address - Street 1:8845 MD BUSH DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1338
Practice Address - Country:US
Practice Address - Phone:415-819-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95252374163WM0705X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical