| NPI | 1588811988 |
|---|---|
| Former Name | STACY ELIZABETH MELLONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012955) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2023-03-10 |