Healthcare Provider Details

I. General information

NPI: 1700454071
Provider Name (Legal Business Name): FRUMENTIA MELISSA LEON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date: 12/01/2022
Reactivation Date: 09/01/2023

III. Provider practice location address

301 MEMORIAL MEDICAL PKWY
DAYTONA BEACH FL
32117-5167
US

IV. Provider business mailing address

506 6TH STREET, DEPARTMENT OF ANESTHESIOLOGY NEW YORK PRESBYTERIAN-BROOKLYN METHODIST HOSPITAL
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-3147
  • Fax: 386-231-3695
Mailing address:
  • Phone: 718-780-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME177444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: