Individual
CHARLES MELLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
(631) 686-7653
Mailing address
75 N COUNTRY RD, PORT JEFFERSON, NY 11777-2119
(631) 473-1320
(631) 686-7653
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004335
NY
Other
Enumeration date
10/10/2006
Last updated
10/22/2015
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