Healthcare Provider Details

I. General information

NPI: 1912532060
Provider Name (Legal Business Name): GISELLE MEJIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 CORAL WAY STE 110A
MIAMI FL
33145-3214
US

IV. Provider business mailing address

3400 CORAL WAY STE 202
MIAMI FL
33145-3053
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1999
  • Fax:
Mailing address:
  • Phone: 305-856-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number17081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: