Provider Demographics
NPI:1518634336
Name:MALLON, MELINDA MARY (NP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MARY
Last Name:MALLON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:MALLON
Other - Last Name:JANAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 CENTRAL AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2506
Mailing Address - Country:US
Mailing Address - Phone:603-749-0001
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2506
Practice Address - Country:US
Practice Address - Phone:603-749-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05341823363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care