Healthcare Provider Details

I. General information

NPI: 1972656312
Provider Name (Legal Business Name): MELISSA LYNN TRACHTENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA LYNN COOPER-TRACHTENBERG PA-C

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

IV. Provider business mailing address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-2444
  • Fax: 954-491-8818
Mailing address:
  • Phone: 954-491-2444
  • Fax: 954-491-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101170
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: