Healthcare Provider Details

I. General information

NPI: 1659684090
Provider Name (Legal Business Name): MELANIE SMITH BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 NW 83RD ST
GAINESVILLE FL
32606-6227
US

IV. Provider business mailing address

3303 NW 83RD ST.
GAINESVILLE FL
32606
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-4060
  • Fax:
Mailing address:
  • Phone: 352-334-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-03-1089
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: