Provider Demographics
NPI:1275086878
Name:CONNALLY, MELISSA LONDONO
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LONDONO
Last Name:CONNALLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ERNESTINA
Other - Last Name:LONDONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 KELMSLEY CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5834
Mailing Address - Country:US
Mailing Address - Phone:214-726-2814
Mailing Address - Fax:
Practice Address - Street 1:1620 KELMSLEY CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5834
Practice Address - Country:US
Practice Address - Phone:214-726-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program