Healthcare Provider Details

I. General information

NPI: 1558824714
Provider Name (Legal Business Name): MELANIE DEFATIMA VEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 BAPTIST WAY STE 103
HOMESTEAD FL
33033-7600
US

IV. Provider business mailing address

975 BAPTIST WAY STE 103
HOMESTEAD FL
33033-7600
US

V. Phone/Fax

Practice location:
  • Phone: 305-245-4549
  • Fax: 305-245-4590
Mailing address:
  • Phone: 305-245-4549
  • Fax: 305-245-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME159309
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME159309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: