Provider Demographics
NPI:1366076200
Name:D'MELLO, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:D'MELLO
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 1:5500 FIELDSTON RD APT 8JJ
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2537
Mailing Address - Country:US
Mailing Address - Phone:347-517-2671
Mailing Address - Fax:
Practice Address - Street 1:5500 FIELDSTON RD APT 8JJ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2537
Practice Address - Country:US
Practice Address - Phone:347-517-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty