Provider Demographics
NPI:1821795030
Name:MELLINGER, MARISSA LYNN
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:MELLINGER
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 1:25 HEATHCOTE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4732
Mailing Address - Country:US
Mailing Address - Phone:732-570-4229
Mailing Address - Fax:
Practice Address - Street 1:631 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716-2010
Practice Address - Country:US
Practice Address - Phone:302-831-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE22OtherRESPIRATORY, REHABILITATIVE, RESTORATIVE SERVICE PROVIDERS