Healthcare Provider Details

I. General information

NPI: 1609640978
Provider Name (Legal Business Name): MS. MELIS EDA GERCEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 SW 128TH ST
MIAMI FL
33186-5899
US

IV. Provider business mailing address

14250 SW 73RD AVE
PALMETTO BAY FL
33158-1691
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-3451
  • Fax:
Mailing address:
  • Phone: 305-873-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: