Provider Demographics
NPI:1528383320
Name:SGRO, MELISSA DIANA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DIANA
Last Name:SGRO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 VIRGINIA PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5557
Mailing Address - Country:US
Mailing Address - Phone:631-487-6026
Mailing Address - Fax:
Practice Address - Street 1:11 THERESA CT
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1434
Practice Address - Country:US
Practice Address - Phone:631-487-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006451213E00000X
TX3009213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist