Healthcare Provider Details

I. General information

NPI: 1417943564
Provider Name (Legal Business Name): ELLIOT MELENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON STREET PEDIATRIC INTENSIVE CARE UNIT
HARTFORD CT
06106
US

IV. Provider business mailing address

282 WASHINGTON STREET PEDIATRIC INTENSIVE CARE UNIT
HARTFORD CT
06106
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5455
  • Fax: 727-767-4970
Mailing address:
  • Phone: 860-837-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number128818
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number128818
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number66876
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: