Healthcare Provider Details

I. General information

NPI: 1164079711
Provider Name (Legal Business Name): MELANIE VILLALOBOS MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 SW 36TH ST STE 9
DAVIE FL
33328-1915
US

IV. Provider business mailing address

134 TINY FLOWER RD
DAVENPORT FL
33837-8649
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-7790
  • Fax: 954-577-7780
Mailing address:
  • Phone: 305-281-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: