Healthcare Provider Details

I. General information

NPI: 1003599002
Provider Name (Legal Business Name): MELANI BELLO ALFONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7982 CARRIAGE POINTE DR
GIBSONTON FL
33534-3007
US

IV. Provider business mailing address

7982 CARRIAGE POINTE DR
GIBSONTON FL
33534-3007
US

V. Phone/Fax

Practice location:
  • Phone: 156-255-6103
  • Fax:
Mailing address:
  • Phone: 562-556-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: