Provider Demographics
NPI:1174390637
Name:BOSIRE, MELCHIZEDEC OUKO (PMHNP)
Entity type:Individual
Prefix:
First Name:MELCHIZEDEC
Middle Name:OUKO
Last Name:BOSIRE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-2407
Mailing Address - Country:US
Mailing Address - Phone:267-400-0255
Mailing Address - Fax:
Practice Address - Street 1:590 NAAMANS RD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2308
Practice Address - Country:US
Practice Address - Phone:302-588-8649
Practice Address - Fax:302-385-2080
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010545363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health