Healthcare Provider Details

I. General information

NPI: 1780105577
Provider Name (Legal Business Name): MELISSA GALLO MS.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NESHAMINY INTERPLEX DR STE 202
FEASTERVILLE TREVOSE PA
19053-6940
US

IV. Provider business mailing address

4 NESHAMINY INTERPLEX DR STE 202
TREVOSE PA
19053-6940
US

V. Phone/Fax

Practice location:
  • Phone: 914-319-5090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH004512
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: