Provider Demographics
NPI:1528331444
Name:DEMELO, MARILYN (RN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:DEMELO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 BRONXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1104
Mailing Address - Country:US
Mailing Address - Phone:914-282-0164
Mailing Address - Fax:
Practice Address - Street 1:426 BRONXVILLE RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10708-1104
Practice Address - Country:US
Practice Address - Phone:914-282-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6468901163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse