Provider Demographics
NPI:1497029177
Name:GALLOWAY, MELYSSA MIYAKO JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:MELYSSA
Middle Name:MIYAKO JOHNSON
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELYSSA
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE # LL140
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-688-5000
Mailing Address - Fax:425-688-5009
Practice Address - Street 1:1135 116TH AVE NE # LL140
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-688-5000
Practice Address - Fax:425-688-5009
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60969397208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics