Healthcare Provider Details

I. General information

NPI: 1558732446
Provider Name (Legal Business Name): VIKTORIYA MELLADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIKTORIYA SENKIV NP

II. Dates (important events)

Enumeration Date: 10/17/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 248-661-7111
  • Fax:
Mailing address:
  • Phone: 800-436-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704287937
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8062
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: