Provider Demographics
NPI:1215482542
Name:MELORO, NEIL RAYMOND (ED S)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:RAYMOND
Last Name:MELORO
Suffix:
Gender:M
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W GRAND VALLEY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORWELL
Mailing Address - State:OH
Mailing Address - Zip Code:44076-9437
Mailing Address - Country:US
Mailing Address - Phone:440-437-6260
Mailing Address - Fax:
Practice Address - Street 1:111 W GRAND VALLEY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORWELL
Practice Address - State:OH
Practice Address - Zip Code:44076-9437
Practice Address - Country:US
Practice Address - Phone:440-437-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3227548103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool