Healthcare Provider Details

I. General information

NPI: 1154411478
Provider Name (Legal Business Name): MARIA WILMA D'MELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 STATE ROUTE 18 WEST FERRIS PLAZA UNIT K
EAST BRUNSWICK NJ
08816-5703
US

IV. Provider business mailing address

385 STATE ROUTE 18 WEST FERRIS PLAZA UNIT K
EAST BRUNSWICK NJ
08816-5703
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-4344
  • Fax: 732-238-6981
Mailing address:
  • Phone: 732-238-4344
  • Fax: 732-238-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA041069
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: