Healthcare Provider Details

I. General information

NPI: 1609475698
Provider Name (Legal Business Name): MELANIE CALZADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 SW 18TH PL
CAPE CORAL FL
33914-6240
US

IV. Provider business mailing address

4330 SW 18TH PL
CAPE CORAL FL
33914-6240
US

V. Phone/Fax

Practice location:
  • Phone: 786-663-6956
  • Fax:
Mailing address:
  • Phone: 786-663-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13722
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-131938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: