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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

Other

Enumeration date
11/15/2022
Last updated
11/15/2022
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