Provider Demographics
NPI:1013275213
Name:MELLA, DIVYA (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:MELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:SUITE J3.116 MC:9036
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-648-3116
Mailing Address - Fax:214-648-5080
Practice Address - Street 1:3410 WORTH ST STE 820
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-8690
Practice Address - Fax:214-820-8691
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2019-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR21712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology