Provider Demographics
NPI:1134150709
Name:AQUILO, MELISSA DAWN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:AQUILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SHUMATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:7238 MECHANICSVILLE TPKE
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3502
Practice Address - Country:US
Practice Address - Phone:804-559-9900
Practice Address - Fax:804-559-6530
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110008522Medicaid
H70316Medicare UPIN
VA022493P95Medicare PIN
VA110008522Medicaid