Healthcare Provider Details

I. General information

NPI: 1063476950
Provider Name (Legal Business Name): MARILEE M MEELER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 12TH ST STE 103
KEY WEST FL
33040-4084
US

IV. Provider business mailing address

1111 12TH ST STE 103
KEY WEST FL
33040-4084
US

V. Phone/Fax

Practice location:
  • Phone: 305-295-3535
  • Fax: 305-294-6868
Mailing address:
  • Phone: 305-295-3535
  • Fax: 954-893-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9102240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: