Basic Information
| Provider Information | |||||||||
| NPI: | 1598017246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | SADIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNIM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10055 BELKNAP RD | ||||||||
| Address2: | #114 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774981102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814955966 | ||||||||
| FaxNumber: | 2814955799 | ||||||||
| Practice Location | |||||||||
| Address1: | 10055 BELKNAP RD | ||||||||
| Address2: | #114 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774981102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814955966 | ||||||||
| FaxNumber: | 2814955799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2012 | ||||||||
| LastUpdateDate: | 10/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | 853 | TX | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.