Provider Demographics
NPI:1356982078
Name:MELTON, DYLAN WAYNE
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:WAYNE
Last Name:MELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38668 FILLY DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1782
Mailing Address - Country:US
Mailing Address - Phone:586-383-4529
Mailing Address - Fax:
Practice Address - Street 1:38668 FILLY DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1782
Practice Address - Country:US
Practice Address - Phone:586-383-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician