Provider Demographics
NPI:1144560954
Name:MELLO, MONIQUE (FNP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PENN PLZ
Mailing Address - Street 2:SUITE 725
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0002
Mailing Address - Country:US
Mailing Address - Phone:917-364-0995
Mailing Address - Fax:347-982-0445
Practice Address - Street 1:1 PENN PLZ
Practice Address - Street 2:SUITE 725
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:917-364-0995
Practice Address - Fax:347-982-0445
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY523006-1163WM0705X
NYF336849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical