=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427174721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH MELLO MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 09/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3295 N DRINKWATER BOULEVARD SUITE 7
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85251-6492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-949-9333
-----------------------------------------------------
Fax | 480-949-9334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85252-0040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-949-9333
-----------------------------------------------------
Fax | 480-949-9334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER A UDELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-949-9333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 17479
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------