Healthcare Provider Details

I. General information

NPI: 1427545045
Provider Name (Legal Business Name): MELISSA MENDOZA SUYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16401 NW 2ND AVE STE 204
NORTH MIAMI BEACH FL
33169-6036
US

IV. Provider business mailing address

2699 STIRLING RD STE B100
FT LAUDERDALE FL
33312-6543
US

V. Phone/Fax

Practice location:
  • Phone: 305-945-4131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME150726
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: