Healthcare Provider Details

I. General information

NPI: 1255752028
Provider Name (Legal Business Name): NATASHA KNIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2013
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 N WICKHAM RD STE 110
MELBOURNE FL
32940-7323
US

IV. Provider business mailing address

5545 N WICKHAM RD STE 110
MELBOURNE FL
32940-7323
US

V. Phone/Fax

Practice location:
  • Phone: 321-779-9838
  • Fax:
Mailing address:
  • Phone: 321-779-9838
  • Fax: 321-779-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: