Healthcare Provider Details

I. General information

NPI: 1124017017
Provider Name (Legal Business Name): MELISSA KIMBERLY MAISENBACHER M.S.,C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD UF PEDIATRIC GENETICS
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

8634 SW 66TH LN
GAINESVILLE FL
32608-5666
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-4104
  • Fax: 352-392-3051
Mailing address:
  • Phone: 352-376-8897
  • Fax: 352-392-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: