Provider Demographics
NPI:1871791160
Name:VELAHOS, MARYELLEN (L AC, DIPL AC)
Entity type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:
Last Name:VELAHOS
Suffix:
Gender:F
Credentials:L AC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3010
Mailing Address - Country:US
Mailing Address - Phone:610-668-1338
Mailing Address - Fax:610-668-1153
Practice Address - Street 1:111 BALA AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3333
Practice Address - Country:US
Practice Address - Phone:610-668-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-07
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA AK 00793171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist