Provider Demographics
NPI:1598469579
Name:MELILLO, ANNA BRIDGET
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BRIDGET
Last Name:MELILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CREST AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1587
Mailing Address - Country:US
Mailing Address - Phone:508-930-0037
Mailing Address - Fax:
Practice Address - Street 1:21 CREST AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-1587
Practice Address - Country:US
Practice Address - Phone:508-930-0037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist