Healthcare Provider Details

I. General information

NPI: 1639435498
Provider Name (Legal Business Name): STEPHANIE ANN MELBOURNE-CARBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS STEPHANIE ANN MELBOURNE

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11495 SW 40TH ST
MIAMI FL
33165
US

IV. Provider business mailing address

11495 SW 40TH ST
MIAMI FL
33165-3311
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME123197
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberME123197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: