Provider Demographics
NPI:1346564804
Name:BELLO, MELISSA A (LPN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:BELLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LAKEWOOD CT APT 19
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-2055
Mailing Address - Country:US
Mailing Address - Phone:631-878-3987
Mailing Address - Fax:
Practice Address - Street 1:1010 ROUTE 112 STE 210
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3097
Practice Address - Country:US
Practice Address - Phone:631-473-1200
Practice Address - Fax:631-473-3592
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293179164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse