Provider Demographics
NPI:1063543312
Name:WHEELER, MELISSA M (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:WHEELER
Suffix:
Gender:F
Credentials:MD
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 71325
Mailing Address - Street 2:SUITE 99
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8425
Mailing Address - Country:US
Mailing Address - Phone:787-447-6646
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE SAN JOSE APT 503
Practice Address - Street 2:FOUNTAINBLUE VILLAGE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4734
Practice Address - Country:US
Practice Address - Phone:787-447-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4041109OtherDRIVERS LICENCE