Provider Demographics
NPI:1356020028
Name:MELLO, CASSIDY MARY (RN)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MARY
Last Name:MELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NORWICH AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:TAFTVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06380-1487
Mailing Address - Country:US
Mailing Address - Phone:508-846-4638
Mailing Address - Fax:
Practice Address - Street 1:611 NORWICH AVE APT 415
Practice Address - Street 2:
Practice Address - City:TAFTVILLE
Practice Address - State:CT
Practice Address - Zip Code:06380-1487
Practice Address - Country:US
Practice Address - Phone:508-846-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT205979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse