Individual
SHASTA MELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
474 W 200 N, ST GEORGE, UT 84770-4505
(435) 634-5600
Mailing address
1372 W 1130 N APT 9, ST GEORGE, UT 84770-4893
(435) 429-5662
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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