Healthcare Provider Details

I. General information

NPI: 1356683395
Provider Name (Legal Business Name): MELISSA A FELLMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2013
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST STE 1383
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1383
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-9173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number132988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: