Healthcare Provider Details

I. General information

NPI: 1104349778
Provider Name (Legal Business Name): MELISSA VELAR EDD, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

IV. Provider business mailing address

2510 CESERY BLVD
JACKSONVILLE FL
32211-3811
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax: 954-866-5513
Mailing address:
  • Phone: 786-857-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-20-11231
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71406
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-48441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: