Healthcare Provider Details

I. General information

NPI: 1740096197
Provider Name (Legal Business Name): MELADY ELIZABETH ROMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELADY ELIZABETH AYALA

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5824 STATE ROAD 54 STE 101
NEW PORT RICHEY FL
34652-6061
US

IV. Provider business mailing address

5824 STATE ROAD 54 STE 101
NEW PORT RICHEY FL
34652-6061
US

V. Phone/Fax

Practice location:
  • Phone: 727-845-1933
  • Fax:
Mailing address:
  • Phone: 727-845-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036719
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: