Provider Demographics
NPI:1598143869
Name:MOSELLO, ANTHONY MILTON
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MILTON
Last Name:MOSELLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:MOSELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7403 SHADYBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-6209
Mailing Address - Country:US
Mailing Address - Phone:314-255-3704
Mailing Address - Fax:
Practice Address - Street 1:7403 SHADYBRIDGE CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-6209
Practice Address - Country:US
Practice Address - Phone:314-255-3704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program