Healthcare Provider Details

I. General information

NPI: 1770030256
Provider Name (Legal Business Name): MELISSA WINTER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14290 METROPOLIS AVE STE 1
FORT MYERS FL
33912-4534
US

IV. Provider business mailing address

14290 METROPOLIS AVE STE 1
FORT MYERS FL
33912-4534
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-1114
  • Fax:
Mailing address:
  • Phone: 239-275-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPR392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: