Provider Demographics
NPI:1780838417
Name:MELO, AMANDA BRYANT (LICAC, DIPLAC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BRYANT
Last Name:MELO
Suffix:
Gender:F
Credentials:LICAC, DIPLAC
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 703761
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-3761
Mailing Address - Country:US
Mailing Address - Phone:972-955-2444
Mailing Address - Fax:972-980-2453
Practice Address - Street 1:5323 SPRING VALLEY RD
Practice Address - Street 2:SUITE #100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2414
Practice Address - Country:US
Practice Address - Phone:972-955-2444
Practice Address - Fax:972-980-2453
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist