Provider Demographics
NPI:1780357103
Name:MELAHN, GABRIELLA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:
Last Name:MELAHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:GABRIELLA
Other - Middle Name:
Other - Last Name:DEPIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:105 RAIDER BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1528
Mailing Address - Country:US
Mailing Address - Phone:973-590-8566
Mailing Address - Fax:
Practice Address - Street 1:105 RAIDER BLVD STE 203
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1528
Practice Address - Country:US
Practice Address - Phone:908-359-8980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00634800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant