MEDICARE: NELLIE MELISSA MILAZZO RBT

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	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician	BACB1084676	FL

General Provider Information

NPI Number	:	1174381248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLIE MELISSA MILAZZO RBT

Provider Business Mailing Address
First Line	:	168 WASHINGTON AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-2923
Country	:	US
Telephone Number	:	321-557-4041
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 NE LIMA VIAS
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-6635
Country	:	US
Telephone Number	:	321-557-4041
Fax Number	:

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

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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