Provider Demographics
NPI:1629289970
Name:MAYO, MELISSA A (CDM)
Entity Type:Individual
Prefix:MR
First Name:MELISSA
Middle Name:A
Last Name:MAYO
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 WOOD GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4351
Mailing Address - Country:US
Mailing Address - Phone:801-553-9233
Mailing Address - Fax:801-553-9295
Practice Address - Street 1:1775 WOOD GLEN RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4351
Practice Address - Country:US
Practice Address - Phone:801-553-9233
Practice Address - Fax:801-553-9295
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA20176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife