Healthcare Provider Details

I. General information

NPI: 1770722134
Provider Name (Legal Business Name): MELISSA JENKINS-FERNANDEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 INTERLACHEN RD STE A
MELBOURNE FL
32940-1995
US

IV. Provider business mailing address

7901 4TH ST N # 8763
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 321-497-5500
  • Fax:
Mailing address:
  • Phone: 247-194-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: