Healthcare Provider Details

I. General information

NPI: 1770502726
Provider Name (Legal Business Name): SHEILA M. MELLODY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 MAIN ST STE 1
FARMINGDALE NJ
07727-1341
US

IV. Provider business mailing address

271 GROVE AVE STE E
VERONA NJ
07044-1730
US

V. Phone/Fax

Practice location:
  • Phone: 732-938-6471
  • Fax: 833-488-1209
Mailing address:
  • Phone: 973-559-3700
  • Fax: 833-488-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09267800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: