Healthcare Provider Details

I. General information

NPI: 1033442017
Provider Name (Legal Business Name): MELISSA M. BUNCE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 BROADWAY
FORT MYERS FL
33901-7213
US

IV. Provider business mailing address

3487 BROADWAY
FORT MYERS FL
33901-7213
US

V. Phone/Fax

Practice location:
  • Phone: 393-334-9555
  • Fax: 239-334-2832
Mailing address:
  • Phone: 393-334-9555
  • Fax: 239-334-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6696
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07003
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: