Provider Demographics
NPI:1053114884
Name:MALLARY, MELISSA (DO)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MALLARY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 CALLE CISCO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9188
Mailing Address - Country:US
Mailing Address - Phone:505-470-6376
Mailing Address - Fax:
Practice Address - Street 1:13657 W MCDOWELL RD STE 220
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2603
Practice Address - Country:US
Practice Address - Phone:623-848-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program