Individual
JUSTIN MELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4000
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0004326
CO
363A00000X
Physician Assistant
Primary
PA01914
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81683821
—
CO
Enumeration date
06/30/2015
Last updated
07/29/2026
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