Healthcare Provider Details

I. General information

NPI: 1295669802
Provider Name (Legal Business Name): MELISSA CISNEROS LMT CMLDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

886 110TH AVE N STE 9
NAPLES FL
34108-1876
US

IV. Provider business mailing address

17211 WOODBINE WAY
FORT MYERS FL
33967-2580
US

V. Phone/Fax

Practice location:
  • Phone: 239-207-8277
  • Fax:
Mailing address:
  • Phone: 239-207-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA93423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: