Healthcare Provider Details

I. General information

NPI: 1508669037
Provider Name (Legal Business Name): MEGAN MARIE D'MELLO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 GRAND PRAIRIE PKWY STE A
WAUKEE IA
50263-8979
US

IV. Provider business mailing address

455 S 85TH ST UNIT 2706
WEST DES MOINES IA
50266
US

V. Phone/Fax

Practice location:
  • Phone: 515-644-9100
  • Fax:
Mailing address:
  • Phone: 319-521-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number134784
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: