Healthcare Provider Details

I. General information

NPI: 1477040327
Provider Name (Legal Business Name): JULIA MELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONTAUK HWY
WEST ISLIP NY
11795-4927
US

IV. Provider business mailing address

PO BOX 40410
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 216-644-8808
  • Fax:
Mailing address:
  • Phone: 646-722-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005517RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: