Healthcare Provider Details

I. General information

NPI: 1861704447
Provider Name (Legal Business Name): NITZMARI MELENDEZ-VAZQUEZ M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

IV. Provider business mailing address

615 E PRINCETON ST STE 540
ORLANDO FL
32803-1424
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-9980
  • Fax: 407-303-9987
Mailing address:
  • Phone: 407-303-9980
  • Fax: 407-303-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18478
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number006484
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME130250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: