Healthcare Provider Details

I. General information

NPI: 1821483942
Provider Name (Legal Business Name): MELISSA SUSAN NICOLETTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE FL 5
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE FL 5
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3040
  • Fax: 321-841-3049
Mailing address:
  • Phone: 321-841-3040
  • Fax: 321-841-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME146004
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME146004
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-19703
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: