MEDICARE: GIANNA LYNN SABADO MELENDEZ ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096003794	IL

General Provider Information

NPI Number	:	1093124125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANNA LYNN SABADO MELENDEZ ATC

Provider Business Mailing Address
First Line	:	2332 FLAT ROCK CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 FLAT ROCK CT
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-4341
Country	:	US
Telephone Number	:	630-730-2585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2014
Last Update Date	:	08/02/2014

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