Provider Demographics
NPI:1730172412
Name:MELILLO, MARGO M (APRN)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:M
Last Name:MELILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CRICKET KNL
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3915
Mailing Address - Country:US
Mailing Address - Phone:860-257-3606
Mailing Address - Fax:
Practice Address - Street 1:NP CARE, LLC
Practice Address - Street 2:SIX CORPORATE DRIVE, SUITE 420
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6270
Practice Address - Country:US
Practice Address - Phone:203-925-9600
Practice Address - Fax:203-926-0594
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001355363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234803Medicaid
CT004234803Medicaid