Healthcare Provider Details

I. General information

NPI: 1780624262
Provider Name (Legal Business Name): MICHELLE L. MELLION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST SUITE 555
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

2 DUDLEY ST SUITE 555
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3032
  • Fax: 401-444-3205
Mailing address:
  • Phone: 401-444-3032
  • Fax: 401-444-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD12012
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD12012
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: