Provider Demographics
NPI:1134666183
Name:MEELLUS, SUZIE
Entity Type:Individual
Prefix:
First Name:SUZIE
Middle Name:
Last Name:MEELLUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SW 75TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1343
Mailing Address - Country:US
Mailing Address - Phone:404-384-2841
Mailing Address - Fax:
Practice Address - Street 1:408 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-1343
Practice Address - Country:US
Practice Address - Phone:404-384-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide