Individual
MELINDA MANTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 TALLOW WOOD DR, SUITE 8, CLIFTON PARK, NY 12065-2807
(518) 373-4400
(518) 383-7330
Mailing address
PO BOX 689, TROY, NY 12181-0689
(518) 268-5000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
221145
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02252293
—
NY
Enumeration date
03/28/2006
Last updated
05/12/2008
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