Provider Demographics
NPI:1538653175
Name:COLLADO MERCADO, MELISSA (AUD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:COLLADO MERCADO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0437
Mailing Address - Country:US
Mailing Address - Phone:787-393-2816
Mailing Address - Fax:
Practice Address - Street 1:PLAZA MONSERRATE SHOPPING CENTER B-1
Practice Address - Street 2:CARR #2 KM 164.5 INT
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-560-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist