Provider Demographics
NPI:1154173128
Name:MELITO, WILLIAM MITCHELL
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:MELITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NORTHLINE ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4437
Mailing Address - Country:US
Mailing Address - Phone:504-237-5433
Mailing Address - Fax:
Practice Address - Street 1:611 NORTHLINE ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4437
Practice Address - Country:US
Practice Address - Phone:504-237-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program