Healthcare Provider Details

I. General information

NPI: 1861707457
Provider Name (Legal Business Name): MELANIE MELENDEZ GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 N CENTRAL AVE
KISSIMMEE FL
34741-4407
US

IV. Provider business mailing address

13920 LANDSTAR BLVD # 45
ORLANDO FL
32824-5524
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-4795
  • Fax: 863-250-1174
Mailing address:
  • Phone: 863-800-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number12,636 - I
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20857
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME-119966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: