Provider Demographics
NPI:1588692271
Name:MELLO, JUDITH ANN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:MELLO
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 40
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-0040
Mailing Address - Country:US
Mailing Address - Phone:480-949-9333
Mailing Address - Fax:480-949-9334
Practice Address - Street 1:3295 N DRINKWATER BOULEVARD
Practice Address - Street 2:SUITE 7
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6492
Practice Address - Country:US
Practice Address - Phone:480-949-9333
Practice Address - Fax:480-949-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0732810OtherBCBS
AZ128836Medicaid
AZ128836Medicaid
AZF00945Medicare UPIN