Individual
MELODY SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 PRIMACY PKWY, MEMPHIS, TN 38119-0213
(901) 866-8812
Mailing address
1068 CRESTHAVEN RD STE 300, MEMPHIS, TN 38119-0809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
74109
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W259481522
AETNA
—
Enumeration date
03/23/2022
Last updated
07/31/2025
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