Healthcare Provider Details

I. General information

NPI: 1174389985
Provider Name (Legal Business Name): MELANIE CHACON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

IV. Provider business mailing address

315 NE 10TH AVE
CRYSTAL RIVER FL
34429-4456
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-7006
  • Fax:
Mailing address:
  • Phone: 352-795-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21644
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: