Healthcare Provider Details

I. General information

NPI: 1427510650
Provider Name (Legal Business Name): MELODY A INGALLS HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 E MERRITT ISLAND CSWY STE 6
MERRITT ISLAND FL
32952-3651
US

IV. Provider business mailing address

262 E MERRITT ISLAND CSWY STE 6
MERRITT ISLAND FL
32952-3651
US

V. Phone/Fax

Practice location:
  • Phone: 321-452-9053
  • Fax: 321-459-5039
Mailing address:
  • Phone: 321-452-9053
  • Fax: 321-459-5039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: