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Organization
WAGNER MELLO PRIMARY CARE LLC
Active
Organization
WAGNER MELLO PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAGNER MELLO NP (OWNER)
(631) 404-7073
Entity
Organization
Contact information
Practice address
450 SUNRISE HWY, ROCKVILLE CENTRE, NY 11570-5053
(631) 404-7073
(631) 751-8298
Mailing address
610 W 150TH ST APT 3G, NEW YORK, NY 10031-2414
(631) 404-7073
(631) 751-8298
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
NULL
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/15/2022
Last updated
11/15/2022
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