Healthcare Provider Details

I. General information

NPI: 1184417602
Provider Name (Legal Business Name): MELANIE WENDY CASTRO MOLLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date: 04/02/2026
Reactivation Date: 05/20/2026

III. Provider practice location address

AVENIDA ANGAMOS 2520
LIME LIMA
15038
PE

IV. Provider business mailing address

39 HERRICK RD UNIT 101
NEWTON MA
02459
US

V. Phone/Fax

Practice location:
  • Phone: 617-582-8410
  • Fax:
Mailing address:
  • Phone: 617-631-7189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: