Provider Demographics
NPI:1447212287
Name:DEMELLO, DAPHNE E (MD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:E
Last Name:DEMELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAPHNE
Other - Middle Name:E
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BLDG C MANAGED CARE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-546-0486
Mailing Address - Fax:602-546-1631
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-546-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34732207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ985731Medicaid
107572Medicare ID - Type Unspecified
AZ985731Medicaid