Provider Demographics
NPI:1851709877
Name:MELO, BETHANY ANNE (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:MELO
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:ANNE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:4755 OGLETOWN STANTON RD FL 3
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-2200
Mailing Address - Country:US
Mailing Address - Phone:302-733-3475
Mailing Address - Fax:302-325-7056
Practice Address - Street 1:4755 OGLETOWN STANTON RD FL 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-3475
Practice Address - Fax:302-325-7056
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031316363AM0700X
DEC5-0000953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical