Healthcare Provider Details

I. General information

NPI: 1730911140
Provider Name (Legal Business Name): KELSEY ROSE MELLO MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EAGLE RD
ST DAVIDS PA
19087-3617
US

IV. Provider business mailing address

84 STAMFORD ST
FALL RIVER MA
02720-7011
US

V. Phone/Fax

Practice location:
  • Phone: 508-663-8469
  • Fax:
Mailing address:
  • Phone: 508-663-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT008799
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: