Healthcare Provider Details

I. General information

NPI: 1578738415
Provider Name (Legal Business Name): MELISSA DECKER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

IV. Provider business mailing address

1200 SPRING BRANCH RD # A
SAINT JOHNS FL
32259-5285
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-0410
  • Fax: 407-303-0417
Mailing address:
  • Phone: 813-765-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS13661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: