Healthcare Provider Details

I. General information

NPI: 1700719838
Provider Name (Legal Business Name): GABRIELLE ANN MELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CAMPUS DR N
WATERFORD MI
48328-2754
US

IV. Provider business mailing address

339 S BALDWIN RD
OXFORD MI
48371-4107
US

V. Phone/Fax

Practice location:
  • Phone: 248-451-2940
  • Fax:
Mailing address:
  • Phone: 248-906-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: