Healthcare Provider Details

I. General information

NPI: 1366011090
Provider Name (Legal Business Name): MEREDITH MOYA-MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DEL PRADO BLVD S STE 100
CAPE CORAL FL
33990-5617
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-2060
  • Fax: 239-424-2061
Mailing address:
  • Phone: 239-424-2060
  • Fax: 239-424-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: