Provider Demographics
NPI:1932894656
Name:MELLITI MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MELLITI MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENESSIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MELLITI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:813-389-1267
Mailing Address - Street 1:9708 GILESPIE ST STE 109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7614
Mailing Address - Country:US
Mailing Address - Phone:813-389-1267
Mailing Address - Fax:702-405-0625
Practice Address - Street 1:9708 GILESPIE ST STE 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7614
Practice Address - Country:US
Practice Address - Phone:813-389-1267
Practice Address - Fax:702-405-0625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty