Basic Information
| Provider Information | |||||||||
| NPI: | 1356637722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAMATES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 WALTER REED RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153350 | ||||||||
| FaxNumber: | 9103216253 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 WALTER REED RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153350 | ||||||||
| FaxNumber: | 9103216253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2011 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 036-134407 | IL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2019-01477 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.