Healthcare Provider Details

I. General information

NPI: 1174015838
Provider Name (Legal Business Name): MELISSA AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 METROWEST BLVD STE 103
ORLANDO FL
32835-3290
US

IV. Provider business mailing address

14506 QUAIL TRAIL CIR
ORLANDO FL
32837-7077
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-3837
  • Fax: 407-730-3869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: