Healthcare Provider Details

I. General information

NPI: 1508725417
Provider Name (Legal Business Name): MELISSA COSTERO PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7329 PINE VALLEY DR
HIALEAH FL
33015-2228
US

IV. Provider business mailing address

7329 PINE VALLEY DR
HIALEAH FL
33015-2228
US

V. Phone/Fax

Practice location:
  • Phone: 708-369-6846
  • Fax:
Mailing address:
  • Phone: 708-369-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12787
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY12787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: