Healthcare Provider Details

I. General information

NPI: 1407770555
Provider Name (Legal Business Name): MELISSA INGRID COCKLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

3672 SUNGROVE CIR
SANFORD FL
32771-9152
US

V. Phone/Fax

Practice location:
  • Phone: 904-982-2955
  • Fax:
Mailing address:
  • Phone: 904-982-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND8685
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: