Healthcare Provider Details

I. General information

NPI: 1780277426
Provider Name (Legal Business Name): MELANIE FLETCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST STE 109
HOLLYWOOD FL
33026-1501
US

IV. Provider business mailing address

9500 S DADELAND BLVD STE 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-8400
  • Fax: 954-961-8401
Mailing address:
  • Phone: 786-530-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: