MEDICARE: MICHELLE MELO MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	325566-01	NY

General Provider Information

NPI Number	:	1598385809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MELO MD

Provider Business Mailing Address
First Line	:	1262 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3541
Country	:	US
Telephone Number	:	718-569-7929
Fax Number	:	203-573-6707

Provider Business Practice Location Address
First Line	:	1262 BOSTON RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-3541
Country	:	US
Telephone Number	:	718-569-7929
Fax Number	:

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

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	10/17/2023

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