MEDICARE: DR. JEFF NEAL MELVIN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PY9023	FL

General Provider Information

NPI Number	:	1144232885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF NEAL MELVIN PH.D.

Provider Business Mailing Address
First Line	:	13670 METROPOLIS AVE
Second Line	:	SUITE 100
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4346
Country	:	US
Telephone Number	:	239-910-1534
Fax Number	:

Provider Business Practice Location Address
First Line	:	13670 METROPOLIS AVE
Second Line	:	SUITE 101
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4346
Country	:	US
Telephone Number	:	239-910-1534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	09/06/2014

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