Provider Demographics
NPI:1033173372
Name:MELLETTE, JAY DEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:DEE
Last Name:MELLETTE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7123 S DURANGO DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2064
Mailing Address - Country:US
Mailing Address - Phone:702-203-0675
Mailing Address - Fax:702-891-1717
Practice Address - Street 1:980 KELLY JOHNSON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3785
Practice Address - Country:US
Practice Address - Phone:702-352-0200
Practice Address - Fax:702-891-1707
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer