Provider Demographics
NPI:1811660756
Name:MELESE, HERMELLA M
Entity type:Individual
Prefix:
First Name:HERMELLA
Middle Name:M
Last Name:MELESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2593
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-0865
Mailing Address - Country:US
Mailing Address - Phone:571-619-0184
Mailing Address - Fax:804-800-4117
Practice Address - Street 1:43402 APPLE ORCHARD SQ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-7581
Practice Address - Country:US
Practice Address - Phone:571-619-0184
Practice Address - Fax:804-800-4117
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker