Individual
WAGNER B MELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 E. 49TH ST PENTHOUSE, NEW YORK, NY 10016-1201
(631) 404-7073
Mailing address
610 W 150TH ST APT 4J, NEW YORK, NY 10031-2400
(631) 404-7073
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
005922
NY
363L00000X
Nurse Practitioner
F310958-01
NY
Other
Enumeration date
02/16/2017
Last updated
11/07/2022
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