Provider Demographics
NPI:1801539622
Name:MELLO, RICHARD JOSEPH (NP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSEPH
Last Name:MELLO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 ROY RICHARD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2711
Mailing Address - Country:US
Mailing Address - Phone:210-945-2121
Mailing Address - Fax:
Practice Address - Street 1:3071 ROY RICHARD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2711
Practice Address - Country:US
Practice Address - Phone:210-945-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily