Provider Demographics
NPI:1508841248
Name:GALLETTA, MELISSA CAROL (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROL
Last Name:GALLETTA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40487
Mailing Address - Street 2:1432 S DOBSON RD SUITE 301
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274-0487
Mailing Address - Country:US
Mailing Address - Phone:480-464-9400
Mailing Address - Fax:480-464-9401
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-464-9400
Practice Address - Fax:480-464-9401
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008235208000000X, 363A00000X
AZ3224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatrics