MEDICARE: SUZANNE MELLO FNP

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	363LF0000X	Family Nurse Practitioner	17894	CA

General Provider Information

NPI Number	:	1356668370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE MELLO FNP

Provider Business Mailing Address
First Line	:	485 MONTEREY AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95030-5302
Country	:	US
Telephone Number	:	408-354-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	485 MONTEREY AVE
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95030-5302
Country	:	US
Telephone Number	:	408-354-9200
Fax Number	:

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	02/24/2011

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