Healthcare Provider Details

I. General information

NPI: 1568581502
Provider Name (Legal Business Name): MELI ORTHOPEDIC CENTERS OF EXCELLENCE,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NE 20TH TER STE 303
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

PO BOX 162743
ALTAMONTE SPRINGS FL
32716-2743
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8177
  • Fax: 954-771-3629
Mailing address:
  • Phone: 954-580-4084
  • Fax: 954-530-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0057725
License Number StateFL

VIII. Authorized Official

Name: BRIGIDA FENELON
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-451-3010