Healthcare Provider Details

I. General information

NPI: 1619747953
Provider Name (Legal Business Name): MELINDA DAWN SYKES LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N KENTUCKY AVE STE 301
LAKELAND FL
33801-4981
US

IV. Provider business mailing address

1504 WATSON OAKS CT
LAKELAND FL
33809-6864
US

V. Phone/Fax

Practice location:
  • Phone: 863-860-1408
  • Fax:
Mailing address:
  • Phone: 863-860-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA47172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: