Provider Demographics
NPI:1487714770
Name:MELLOR, AMY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:MELLOR
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 1:713 E MARION AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3862
Mailing Address - Country:US
Mailing Address - Phone:941-833-1515
Mailing Address - Fax:
Practice Address - Street 1:713 E MARION AVE STE 125
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3862
Practice Address - Country:US
Practice Address - Phone:941-833-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME990242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology