Provider Demographics
NPI:1780346478
Name:TOMASULO, MELANEE (AGCNS)
Entity type:Individual
Prefix:
First Name:MELANEE
Middle Name:
Last Name:TOMASULO
Suffix:
Gender:F
Credentials:AGCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 CATANDPOLLY LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1182
Mailing Address - Country:US
Mailing Address - Phone:919-622-7301
Mailing Address - Fax:
Practice Address - Street 1:300 KEISLER DR STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7083
Practice Address - Country:US
Practice Address - Phone:919-233-0059
Practice Address - Fax:919-233-0343
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC534364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist